Great strides have been made in moving treatments into the less expensive outpatient setting. Diverticulitis is one disease process that we have become more and more aggressive in our outpatient management and a newly published randomized controlled trial shines high level evidence on this trend.
Article in Annals of Surgery, should be a free PDF too.
In a multicenter randomized controlled trial, researchers randomized uncomplicated diverticulitis patients in to two groups. Group 1 was hospitalized for minimum of 36h and given IV antibiotics and then discharged on PO antibiotics, Group 2 was given IV antibiotics in the ER and sent home on PO antibiotics.
While there were many worthwhile exclusion criteria included one, in particular bothered me “absence of symptom relief (maintenance of tenderness, fever, or/and persistence or worsening of acute pain after analgesic and first doses of antibiotics)” as this seems to subjectively select for the milder forms of diverticulitis. Which also plays out in the analysis of the patient populations as the mean WBC count was 11.1 for the two groups.
Ultimately their analysis demonstrated no difference between the inpatient and outpatient groups. So what does this mean… Unfortunately the most that I can take away from this evidence is that mild diverticulitis should be treated as an outpatient. Most physicians know this and their practice patterns reflect this.
I would have liked to have seen the study without the above mentioned exclusion criteria, to see whether or not the more severe diverticulitis patient’s benefited from hospitalization.