Older patients with diverticulitis have low recurrence rates and rarely need surgery

Background: In a cohort of older patients with newly diagnosed diverticulitis, we aimed to describe diverticulitis recurrence and need for an operation based on patient age and site of initial care. Methods: This retrospective, longitudinal, cohort study used data from the 5% Medicare Provider Analysis and Review inpatient and outpatient files from January 1, 2003, through December 31, 2007. An incident cohort of patients with diverticulitis was identified. Patients undergoing left colectomy, colostomy, or ileostomy were considered to have undergone diverticulitis surgery. The primary outcomes of interest were need for operative intervention and number of recurrences. Results: We included 16,048 individuals and followed them for an average of 19.2 months; their mean age was 77.8 years. Among those with initial inpatient care, 14.0% underwent operations and 82.5% had no further recurrences. Of patients initially managed nonoperatively, 97% did not go on to have surgery. Individuals treated as outpatients upon first presentation, and patients ≥80, were significantly less likely to have recurrent episodes and were less likely to require an operation. Conclusion: The majority of elderly patients newly diagnosed with diverticulitis did not have an operation or experience recurrent episodes. The apparent benign course of this disease in this population suggests that a conservative approach to the management may be appropriate.