Readmission Risk of Colonic Diverticulitis after Conservative Treatment: A 10-year Comprehensive National Cohort Study

結腸憩室炎保守治療後再入院之發生率及風險因子：國內10年全國統計分析

陳怡潔(Yi-Chieh Chen) ； 宋翎巧(Ling-Chiao Song) ； 陳興保(Hsin-Pao Chen) ； 劉廣文(Kuang-Wen Liu) ； 陳建翰(Jian-Han Chen) ； 陳致一(Chih-I Chen)

《中華民國大腸直腸外科醫學會雜誌》 31卷2期 (2020/06) Pp. 91-100

https://doi.org/10.6312/SCRSTW.202006_31(2).10829

摘要

Purpose. The incidence of diverticulitis is increasing steadily every year. The majority of clinical doctors prefer to treat minor cases of diverticulitis conservatively. However, those who have undergo non-surgical treatment for the first episode of colonic diverticulitis may still require surgery if diverticulitis recurs. The aim of this study is to identify the rate and the risk factors for readmission for diverticulitis after conservative treatment. Methods. This large cohort retrospective study used data from the Taiwan National Health Insurance Research Database for 2000-2010. The study included patients aged 18 years or older with the diagnosis code for colon diverticulitis (ICD-9 codes 562.11) as either a primary or secondary diagnosis. We used Clinical Classification Software codes (CCS) to identify the patients receiving colectomy with surgical complications or not. All patients were followed up until recurrence, death, or 2013/12/31. Results. Of the 27,556 patients who admitted for diverticulum and received non-colectomy treatment with median 72.57 months were included for analysis. The readmission rate of diverticulitis was approximately 9.1% (2,518/27,556) patients after a median follow-up of 21.35 months. However, during the second episode of diverticulitis, it could be subsided in 2,162 patients (85.86%) with conservative treatment. Multivariate logistic regression analysis demonstrated that age ＞ 32.5 years, male sex, Length of hospital stay (LOH) ＞ 5 days, history of peptic ulcer disease, and hyperlipidemia were risk factors for readmission. When patient had more than 2 risk factors, it had 70.65% positive predict value, 95.90% negative predict value, 39.61% sensitivity and 98.85% specificity to predict the readmission for diverticulitis within 2 years (AUC = 0.583, p ＜ 0.001). Conclusions. In Taiwan, most of the patients receive conservative treatment during their first episode of diverticulitis. For those who receive conservative treatment, the readmission rate is 9.1%. The risk factors for readmission of diverticulitis are age ＞ 32.5 years, male sex, LOH ＞ 5 days, history of peptic ulcer disease, and hyperlipidemia were risk factors for readmission. Patients with 2 risk factors had 70.65% positive predict value to predict 2^(nd) admission within 2 years. However, whether elective colectomy recommended or not still remains unclear.

關鍵字

Diverticulitis ； Recurrence ； Readmission ； Colectomy ； Colostomy

並列摘要

目的：憩室炎的發病率每年都在逐步上升。對於較輕微的憩室炎病例，大多數臨床醫生還是選擇保守治療。然而，一旦憩室炎再復發，對第一次接受非手術治療的病人，還是可能需要手術治療。因此，本研究的目的為分析保守治療後憩室炎再入院的發生率及其危險因子。方法：這項大型回溯性研究使用了台灣國家健康保險研究數據庫2000－2010年的數據。該研究對象以年齡在18歲以上且診斷為結腸憩室炎（ICD-9代碼562.11）的患者作為主要及再復發診斷。我們使用臨床分類軟體代碼（CCS）來識別患者是否接受結腸切除術及術後有無手術併發症。對所有患者進行追蹤，直至2013/12/31或復發、死亡。結果：在27,556例患有憩室炎並接受了保守治療的患者中，9.1%（2,518/27,556）的患者於中位數21.35個月後再次因憩室炎住院。然而，因第二次憩室炎發作住院之病患中，仍有2,162（85.86%）位患者經保守治療後出院。多元邏輯回歸分析顯示年齡超過32.5歲、男性、首次住院超過5天、潰瘍病史和高脂血症是再入院的危險因素。當患者擁有超過兩個危險因子以上時，預測兩年內再因憩室炎住院的陽性預測值（PPV）為70.65%，陰性預測值為95.90%（AUC = 0.583, p ＜ 0.001）。結論：在台灣，對於接受保守治療的患者，再入院率為9.1%。風險因素是年齡超過32.5歲、男性、首次住院超過5天、潰瘍病史和高脂血症。當患者擁有超過兩個危險因子以上時，預測兩年內再因憩室炎住院的陽性預測值（PPV）為70.65%。是否推薦選擇性結腸切除術仍無定論，還是需要再進一步研究。

並列關鍵字

憩室炎 ； 復發 ； 再入院 ； 結腸切除術 ； 結腸造口術

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