Diverticular disease is a condition characterized by the formation of small bulges or pockets (diverticula) in the lining of the intestine. Complications of diverticular disease include the formation of abscesses and holes in the bowel called perforation. These complications often require surgery to treat them which is associated with a high risk of death and complications. There has therefore been interest in using less invasive methods such as key-hole surgery to reduce the risk of complications. Currently there are no studies that report on the short and long term results of these techniques. Using large databases of electronic health records, we intend to study patients with these complications of diverticular disease and report how frequently they occur, how often people die following them and from what causes. We will also report what the outcomes from these minimally invasive techniques are in terms of the need for further surgical intervention, stoma formation and re-admission to hospital. The potential benefit of this research is that it will enable practitioners to inform patients of the outcomes of these procedures which will aid in their decision making when being offered these treatments.
Diverticular disease is one of the most common problems encountered by general surgeons and gastroenterologists. Complications of diverticular disease such as perforation and abscess account for the majority of the morbidity and mortality associated with diverticular disease. Given the age and comorbidity of these patients and the high risks of stoma formation and death following surgery there has been interest in pursuing less invasive methods of treatment for these complications. The Association of Coloproctologists of Great Britain and Ireland undertook a modified Delphi exercise during 2014 and 2015 to prioritise research questions for Bowel Disease in conjunction with the Bowel Disease Research Foundation. One of the top ten priority questions in non-cancer diseases was to investigate short and long term outcomes of minimally invasive approaches (e.g. percutaneous radiological drainage, laparoscopic washout and drainage) to managing complicated diverticulitis. The aim of our study will first be to provide contemporary population based estimates of the incidence of perforated diverticular disease and diverticular abscess and quantify the attributable mortality after adjustment for baseline comorbidity. Then, using the cohorts defined, we aim to report the use of minimally invasive treatment strategies and their outcomes in patients with complicated diverticular disease(CDD).
Objective 1: No outcome other than the occurrence of the disease is required for this analysis. Objective 2: Primary outcome measures are death and cause of death. Death will be defined based on recordings of death dates in CPRD, HES or ONS register. To define cause of death, the ONS death register would be used and underlying cause of death will be examined primarily categorized as ICD-10 chapter headings. Objective 3: Primary outcome measures are interventions and outcome of interventions ( readmission and reoperation). Using Linked HES data and OPCS codes, interventions undertaken following an admission with diverticular perforation or diverticular abscess will be identified. Identified interventions would be categorized into: 1. Conservative treatment (no surgical intervention/antibiotics) 2. Laparoscopic lavage 3. Resectional surgery (Hartmann's or resection and anastomosis) 4. Percutaneous drainage Using the same data, re-admission and surgical re-operation following conservative and minimally invasive interventions will be examined.
David Humes - Chief Investigator - University of Nottingham
Harmony Otete - Corresponding Applicant - University Of Central Lancashire
Colin Crooks - Collaborator - University of Nottingham
Joe West - Collaborator - University of Nottingham
HES Accident and Emergency;HES Admitted Patient Care;HES Diagnostic Imaging Dataset;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation