Analysis of the hospital cost impact of diverticular disease: Evaluation of inpatient and outpatient laboratory and surgical procedures.

background

Diverticular disease (DD) is a common disease in Italy and other Western countries [1‐3]. The prevalence of diverticulosis in the general population is thought to be approximately 27% and increases with age. [4]. Nevertheless, we could not find much documented data in the literature regarding the impact of DD on health system costs and activities. In fact, there is only one clinical study in the literature that has evaluated this aspect of DD. [5]. According to this study conducted at the James Cook University Hospital in the UK, DD accounted for 5.3% of the total general surgery budget. The aim of our study was to record the clinical workload and calculate the financial costs incurred by his DD at his AOU Federico II in Naples.

method

We obtained a list of all hospital discharge records (SDOs) coded as having diverticular disease as the presenting symptom (corresponding to ICD-9cm: 562.10; 562.11; 562.12; 562.13) during a 7-year period from 2004 to 2010. . From AOU Federico II Health Department.

This is the result of a computer search of the Health Department’s archives. Discharge records (SDO) were divided into inpatient and outpatient access. SDOs were also divided by hospital departments.

To simplify this segmentation, five macrogroup departments were created: general surgery, gastroenterology, internal medicine, geriatrics, and others.

Parameters investigated included hospitalization, outpatient access, length of stay, diagnostic tests, surgeries, and financial reimbursement.

Results and discussion

A total of 738 patients were treated from January 2004 to December 2010. There were 840 discharge records corresponding to these patients, of which 427 were inpatient and 413 were outpatient.

Diverticular disease accounted for 0.19% of inpatient admissions and 0.13% of outpatient admissions. These patients generated a total of 4,101 inpatient days (representing 0.29% of the hospital’s total inpatient days) and 753 day care visits (representing 0.12% of the hospital’s total outpatient visits).

Data analysis shows that hospitalizations decreased by 24% in 2008 compared to 2004 and by 44% in 2010 compared to 2004. This decrease was associated with a decrease in the number of hospitalizations. Therefore, it will not cause statistically significant changes for all diseases across hospitals.

Hospital admissions for diverticular disease were unevenly distributed among departments. In fact, 74% of his inpatient admissions were recorded in the general surgery department and 16.39% in the gastroenterology department (Figure 1). 1). Similar results were observed in outpatient admissions, where 68.52% of his outpatient admissions were recorded in general surgery and 18.64% in gastroenterology (Figure 1).2).

These two wards therefore had a greater relative prevalence of diverticular disease than the inpatient admissions recorded throughout the hospital. In fact, it accounted for 1% of inpatient admissions, 0.89% of outpatient general surgery, and 1.53% of inpatient admissions and 1.30% of outpatient gastroenterology (Figure 2).3).

Tests used (excluding blood tests) included 416 endoscopy, 197 abdominal CT scan, 177 abdominal ultrasound scan, 109 X-ray, 95 biopsy, 49 fecal examination, and scintigraphy. There were 4 scans, 4 laparotomy, and 4 laparoscopy (Figure 1).Four).

A total of 193 surgical procedures were performed. These consisted of his 68 her sigmoidectomies, his 58 left colectomies, and his only 13 colostomies. The ratio between the number of surgeries and hospitalizations in general surgery was approximately 60% (Table 1).1).

table 1

Surgical interventions performed for diverticular disease between 2004 and 2010

sigmoidectomy	68	35.2%
left hemicolectomy	58	30.1%
total colectomy	9	4.7%
Other partial colectomies	34	17.6%
Artificial opening intervention	20	10.4%
intestinal anastomosis	Four	2%
total	193	100%

The total cost of DD was 1.656.802 euros. This amount represented his 0.2% of the hospital’s total budget. The bulk of the costs, 1,346,218 euros, came from the general surgery department, accounting for 0.9% of the departmental budget, and 182,124 euros came from the gastroenterology department, accounting for 1.02% of the departmental budget.

Our data show a very different environment compared to James Cook University Hospital. In fact, DD accounts for only 0.9% of the general surgery budget of his AOU Federico II in Naples and his 0.2% of the hospital’s overall budget.

The main reason for this difference may be the absence of an emergency department at AOU Federico II. DD is considered one of the most common causes of admission to surgical wards, and the presence of diverticulitis and its complications are the main causes of hospitalization for diverticular disease. [6‐9]. This is confirmed by case studies reported in the literature, according to which approximately 90% of surgical procedures for DD are performed in emergency situations. [10, 11].

Our hypothesis is supported by diagnostic and surgical treatment data.

First of all, we observe that in the presence of acute inflammation, endoscopy is not performed, which is contraindicated. [2, 12, 13], accounting for approximately 40% of diagnostic tests, compared to only 18% for CT scans. This initial finding suggests that our hospital primarily admits patients with non-acute diverticular disease in the interictal phase. [14].

Second, our data show that a total of 159 partial colectomies were performed, whereas only 13 colostomies were performed. As is well known, in the presence of complications of diverticulitis, the creation of a colostomy is necessary, but in the absence of an emergency, resection with a primary anastomosis is preferable. [2, 11]. This data also confirms that there are many patients in a non-acute phase at the time of admission.

Additionally, at our hospital, the rate of intervention and hospitalization in general surgery was 60% (Figure 1).Five) Meanwhile, at James Cook University Hospital, only 13% of patients underwent surgery. [5]. This finding makes the differential impact of DD on the budgets of our general surgery department and James Cook University Hospital even more significant.

competing interests

The authors declare that they have no competing interests.

Author contributions

GA, BA: conception and design, interpretation of data, final approval of version to be published. AG, AC, AF, FG, AB, MBC, FT, GM: acquisition of data, drafting of the manuscript, final approval of the version to be published. FC: acquired data, drafted the manuscript, and gave final approval of the version to be published.

background

method

Results and discussion

competing interests

Author contributions

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