Introduction: Our aim was to assess the impact of the Diagnostic and Therapeutic Assistance Pathway (PDTA) developed for acute diverticulitis (AD) on the management of patients with AD and referring to the emergency room (ER) in a referral center. Methods: This retrospective study includes all patients diagnosed with AD and referring to the ER between January 1, 2021, and December 31, 2022 (after approval of PDTA), compared to the same period of 2015–2019. Length of stay in ER, medical and surgical management, and length in hospital stay (in days) were also measured according to the type of disease (uncomplicated vs. complicated). Results: ER admission due to AD during the period 2015–2019 was 240 ± 13 cases per year, while it was 290 cases in 2022 (p = 0.05). After adopting the PDTA, the rate of length of stay in ER >24 h for AD was significantly reduced (p = 0.01); the median rate of hospital admission for AD was significantly reduced (p < 0.05); the rate of medical treatment of uncomplicated disease was increased (p = 0.01), while the rate of surgical management was decreased (p = 0.05); the rate of medical treatment of complicated disease was increased (p = 0.01), while the rate of surgical management was decreased (p = 0.001); the hospital stay was significantly reduced in both uncomplicated (p = 0.05) and complicated (p = 0.05) AD. Conclusions: The development and the routine use of a PDTA dedicated to AD have significantly improved the management of these patients, reducing the ER stay, the surgical procedures, and the overall hospital stay.

1.
Tursi
A
,
Scarpignato
C
,
Strate
LL
,
Lanas
A
,
Kruis
W
,
Lahat
A
, et al
.
Colonic diverticular disease
.
Nat Rev Dis Primers
.
2020
;
6
(
1
):
20
.
2.
Yang
F
,
Lin
L
,
Jiang
X
,
Lv
H
,
Sun
C
.
Increasing diverticulosis in an aging population: a colonoscopy-based study of 5-year trends in 26 463 patients in northern China
.
Med Sci Monit
.
2018
;
24
:
2825
31
.
3.
Jono
T
,
Kasai
Y
,
Kessoku
T
,
Ogata
T
,
Tanaka
K
,
Yoshihara
T
, et al
.
The prevalence and characteristics of symptomatic uncomplicated diverticular disease among asian patients with unexplained abdominal symptoms
.
J Neurogastroenterol Motil
.
2024
;
30
(
1
):
87
96
.
4.
Binda
GA
,
Mataloni
F
,
Bruzzone
M
,
Carabotti
M
,
Cirocchi
R
,
Nascimbeni
R
, et al
.
Trends in hospital admission for acute diverticulitis in Italy from 2008 to 2015
.
Tech Coloproctol
.
2018
;
22
(
8
):
597
604
.
5.
Mennini
FS
,
Sciattella
P
,
Marcellusi
A
,
Toraldo
B
,
Koch
M
.
Economic burden of diverticular disease: an observational analysis based on real world data from an Italian region
.
Dig Liver Dis
.
2017
;
49
(
9
):
1003
8
.
6.
Etzioni
DA
,
Mack
TM
,
Beart
RW
Jr
,
Kaiser
AM
.
Diverticulitis in the United States: 1998-2005: changing patterns of disease and treatment
.
Ann Surg
.
2009
;
249
(
2
):
210
7
.
7.
Turner
GA
,
O’Grady
MJ
,
Purcell
RV
,
Frizelle
FA
.
Acute diverticulitis in young patients: a review of the changing epidemiology and etiology
.
Dig Dis Sci
.
2022
;
67
(
4
):
1156
62
.
8.
Saren
R
,
Aspegren
S
,
Paajanen
H
,
Ukkonen
M
,
Käkelä
P
.
Incidence of acute diverticulitis compared to appendicitis in emergency wards: a 10-year nationwide register and cohort study from Finland
.
Scand J Gastroenterol
.
2023
;
58
(
2
):
151
6
.
9.
Amato
A
,
Mataloni
F
,
Bruzzone
M
,
Carabotti
M
,
Cirocchi
R
,
Nascimbeni
R
, et al
.
Hospital admission for complicated diverticulitis is increasing in Italy, especially in younger patients: a national database study
.
Tech Coloproctol
.
2020
;
24
(
3
):
237
45
.
10.
Stollman
N
,
Smalley
W
,
Hirano
I
;
AGA Institute Clinical Guidelines Committee
.
American gastroenterological association institute guideline on the management of acute diverticulitis
.
Gastroenterology
.
2015
;
149
(
7
):
1944
9
.
11.
Francis
NK
,
Sylla
P
,
Abou-Khalil
M
,
Arolfo
S
,
Berler
D
,
Curtis
NJ
, et al
.
EAES and SAGES 2018 consensus conference on acute diverticulitis management: evidence-based recommendations for clinical practice
.
Surg Endosc
.
2019
;
33
(
9
):
2726
41
.
12.
Tozzi
VD
.
Gestione per processi e PDTA: alcune riflessioni [process management and PDTA: some reflections]
.
Recenti Prog Med
.
2021
;
112
(
2
):
140
5
. Italian.
13.
Sito aziendale azienda ospedaliera san camillo-forlanini
. Available from: https://www.scamilloforlanini.rm.it/l-ospedale/qualita-e-sicurezza-delle-cure-risk-management/qualita/pdta/pdta-deliberati?limit=20&limitstart=0 (accessed on March 24, 2024).
14.
Monitoraggio e valutazione dei Percorsi Diagnostico-Terapeutico Assistenziali
. Available from: https://www.salute.gov.it/portale/lea/documenti/pdta/Manuale_PDTA_indicatori_all_1_DPCM_parte_generale.pdf (accessed on March 24, 2024).
15.
Tursi
A
,
Brandimarte
G
,
Di Mario
F
,
Lanas
A
,
Scarpignato
C
,
Bafutto
M
, et al
.
International consensus on diverticulosis and diverticular disease. Statements from the 3rd international symposium on diverticular disease
.
J Gastrointestin Liver Dis
.
2019
;
28
(
Suppl 4
):
57
66
.
16.
Hall
J
,
Hardiman
K
,
Lee
S
,
Lightner
A
,
Stocchi
L
,
Paquette
IM
, et al
.
The American society of colon and rectal surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis
.
Dis Colon Rectum
.
2020
;
63
(
6
):
728
47
.
17.
Schultz
JK
,
Azhar
N
,
Binda
GA
,
Barbara
G
,
Biondo
S
,
Boermeester
MA
, et al
.
European Society of Coloproctology: guidelines for the management of diverticular disease of the colon
.
Colorectal Dis
.
2020
;
22
(
Suppl 2
):
5
28
.
18.
International classification of diseases, ninth revision, clinical modification (ICD-9-CM)
. Available from: https://www.cdc.gov/nchs/icd/icd9cm.htm (Accessed on March 24, 2024).
19.
Kaiser
AM
,
Jiang
JK
,
Lake
JP
,
Ault
G
,
Artinyan
A
,
Gonzalez-Ruiz
C
, et al
.
The management of complicated diverticulitis and the role of computed tomography
.
Am J Gastroenterol
.
2005
;
100
(
4
):
910
7
.
20.
Maconi
G
,
Carmagnola
S
,
Guzowski
T
.
Intestinal ultrasonography in the diagnosis and management of colonic diverticular disease
.
J Clin Gastroenterol
.
2016
;
50
(
Suppl 1
):
S20
2
.
21.
Cammarota
S
,
Cargiolli
M
,
Andreozzi
P
,
Toraldo
B
,
Citarella
A
,
Flacco
ME
, et al
.
Increasing trend in admission rates and costs for acute diverticulitis during 2005-2015: real-life data from the Abruzzo Region
.
Therap Adv Gastroenterol
.
2018
;
11
:
1756284818791502
.
22.
Bamanie
HM
,
Malibary
N
,
Algarni
NA
,
Badawi
JO
,
Al Nasser
LM
,
Almalki
KA
, et al
.
Epidemiology, management, and outcomes of acute diverticulitis in king abdul-aziz university hospital, jeddah, Saudi arabia
.
Cureus
.
2022
;
14
(
12
):
e32615
.
24.
Karentzos
A
,
Ntourakis
D
,
Tsilidis
K
,
Tsoulfas
G
,
Papavramidis
T
.
Hinchey Ia acute diverticulitis with isolated pericolic air on CT imaging; to operate or not? A systematic review
.
Int J Surg
.
2021
;
85
:
1
9
.
25.
Papa
A
,
Papa
V
.
The economic burden of diverticular disease
.
J Clin Gastroenterol
.
2016
;
50
(
Suppl 1
):
S2
3
.
26.
Hossain
N
,
Naidu
V
,
Hosny
S
,
Khalifa
M
,
Mathur
P
,
Al Whouhayb
M
.
Hospital presentations of acute diverticulitis during COVID-19 pandemic may be more likely to require surgery due to increased severity: a single-centre experience
.
Am Surg
.
2022
;
88
(
1
):
133
9
.
You do not currently have access to this content.