Addressing the Appropriateness of Elective Colon Resection for Diverticulitis A Report From the SCOAP CERTAIN Collaborative

作者：Simianu Vlad V; Bastawrous Amir L; Billingham Richard P; Farrokhi Ellen T; Fichera Alessandro; Herzig Daniel O; Johnson Eric; Steele Scott R; Thirlby Richard C; Flum David R^*

来源：Annals of Surgery, 2014, 260(3): 533-539.

DOI：10.1097/SLA.0000000000000894

• appropriateness
• benchmarking
• diverticulitis
• elective colectomy
• guidelines

Objective: To assess the reported indications for elective colon resection for diverticulitis and concordance with professional guidelines. %26lt;br%26gt;Background: Despite modern professional guidelines recommending delay in elective colon resection beyond 2 episodes of uncomplicated diverticulitis, the incidence of elective colectomy has increased dramatically in the last 2 decades. Whether surgeons have changed their threshold for recommending a surgical intervention is unknown. In 2010, Washington State%26apos;s Surgical Care and Outcomes Assessment Program initiated a benchmarking and education initiative related to the indications for colon resection. %26lt;br%26gt;Methods: Prospective cohort study evaluating indications from chronic complications (fistula, stricture, bleeding) or the number of previously treated diverticulitis episodes for patients undergoing elective colectomy at 1 of 49 participating hospitals (2010-2013). %26lt;br%26gt;Results: Among 2724 patients (58.7 +/- 13 years; 46% men), 29.4% had a chronic complication indication (15.6% fistula, 7.4% stricture, 3.0% bleeding, 5.8% other). For the 70.5% with an episode-based indication, 39.4% had 2 or fewer episodes, 56.5% had 3 to 10 episodes, and 4.1% had more than 10 episodes. Thirty-one percent of patients failed to meet indications for either a chronic complication or 3 or more episodes. Over the 4 years, the proportion of patients with an indication of 3 or more episodes increased from 36.6% to 52.7% (P %26lt; 0.001) whereas the proportion of those who failed to meet either clinical or episode-based indications decreased from 38.4% to 26.4% (P %26lt; 0.001). The annual rate of emergency resections did not increase significantly, varying from 5.6 to 5.9 per year (P = 0.81). %26lt;br%26gt;Conclusions: Adherence to a guideline based on 3 or more episodes for elective colectomy increased concurrently with a benchmarking and peer-to-peer messaging initiative. Improving adherence to professional guidelines related to appropriate care is critical and can be facilitated by quality improvement collaboratives.

• 出版日期2014-9