Universität zu Köln

Fuchs, Hans F., Broderick, Ryan C., Harnsberger, Cristina R., Chang, David C., Mclemore, Elisabeth C., Ramamoorthy, Sonia and Horgan, Santiago (2015). Variation of outcome and charges in operative management for diverticulitis. Surg. Endosc., 29 (11). S. 3090 - 3097. NEW YORK: SPRINGER. ISSN 1432-2218

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Abstract

Outcomes after surgery for diverticulitis are of continued interest to improve quality of care. The aim of this study was to assess variations in mortality, length of stay, and patient charges between geographic regions of the United States. A retrospective analysis of the Nationwide Inpatient Sample database was performed. Adults with diverticulitis who underwent laparoscopic or open segmental colectomy were identified using ICD-9 codes. Subset analyses were performed by state and then compared. Outcomes included mortality, length of stay (LOS), and total charges. Results were adjusted for age, race, gender, findings of peritonitis, stoma placement, Charlson comorbidity index, and insurance status on multivariate analysis. 148,874 patients underwent segmental colectomy for diverticulitis from 1998 to 2010. Using California as the comparison state and after adjusting for covariates, in-hospital mortality was significantly higher in the State of New York (OR 1.32; 95 % CI 1.13-1.55; P < 0.05) and Mississippi (OR 2.84; 95 % CI 1.24-6.51, P < 0.02). Wisconsin had a significant lower mortality rate (OR 0.74; 95 % CI 0.59-0.94, P < 0.01). LOS was 1.4 days longer in New York and 0.54 days shorter in Wisconsin than in California (P < 0.01). Patients with age > 40 years, findings of peritonitis, and without private insurance had higher in-hospital mortality and longer length of stay. Average hospital charges differed dramatically between the states in the observation period. The highest hospital charges occurred in California, Nebraska, and Nevada while lowest occurred in Maryland, Wisconsin and Utah. Patients who undergo surgical treatment for diverticulitis in the United States have high geographic variation in mortality, LOS, and hospital charges despite adjusting for demographic and socioeconomic factors. Further analysis should be performed to identify the causes of outlier regions, with the goal of improving and standardizing best practices.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Fuchs, Hans F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Broderick, Ryan C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Harnsberger, Cristina R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Chang, David C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mclemore, Elisabeth C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ramamoorthy, Sonia UNSPECIFIED UNSPECIFIED UNSPECIFIED Horgan, Santiago UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-388473
DOI:	10.1007/s00464-014-4046-0
Journal or Publication Title:	Surg. Endosc.
Volume:	29
Number:	11
Page Range:	S. 3090 - 3097
Date:	2015
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1432-2218
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language UNITED-STATES; SURGICAL-PROCEDURES; COLORECTAL-CANCER; DISEASE; SURGERY; OVERUSE; PATTERNS; UNDERUSE; QUALITY Multiple languages Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/38847