Impact of Changing Guidelines on Elective Resection of Uncomplicated Diverticulitis in the United States

Abstract The incidence of diverticulitis has increased in recent years. Management strategies have shifted from routine elective colectomy after two episodes of uncomplicated diverticulitis to more individualized decision-making. To evaluate the impact of updated management guidelines on trends and outcomes of elective colectomy for uncomplicated diverticulitis. A retrospective cohort study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program (2012–2019). Patients undergoing elective colectomy for uncomplicated diverticulitis were included. Exclusion criteria were complicated diverticulitis, emergent surgery, malignancy on final pathology, and ASA score of 5 or unknown. Emergent cases were analyzed only for temporal trends. From 2012 to 2019, elective colectomies for uncomplicated diverticulitis increased from 2,326 (96.7% elective) to 3,740 (98.9% elective) (p < 0.001). After excluding emergent cases, 25,045 patients were analyzed. Overall morbidity decreased from 16.4% to 10.7% (p < 0.001), and serious morbidity from 7.4% to 6.5% (p = 0.005). Other improvements included reductions in reoperation (4.2% to 3.5%), anastomotic leak (3.5% to 2.8%), wound infection (7.7% to 2.9%), transfusion (2.8% to 2.3%), shock/sepsis (3.1% to 2.4%), ileus (7.2% to 5.4%), and median length of stay (4 to 3 days). Operative time increased slightly (172 to 181 minutes, p = 0.002). Ostomy and mortality rates remained unchanged. Despite guideline changes encouraging individualized management, elective colectomies for uncomplicated diverticulitis are increasing, with significantly improved postoperative outcomes, possibly due to better patient selection and surgical care.