The Immediate, Hospital-Level Impact of Stay-at-Home Order on Diverticulitis Burden
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RESEARCH COMMUNICATION
The Immediate, Hospital-Level Impact of Stay-at-Home Order on Diverticulitis Burden Celine Soriano 1 & Jennifer A. Kaplan 1,2 & Joanna K. Law 2,3 & Barbara L. Williams 4 & C. Craig Blackmore 4 & Vlad V. Simianu 1,2 Received: 21 July 2020 / Accepted: 6 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords Diverticulitis . COVID-19 . Colorectal Surgery . Hospitalization
Introduction Diverticulitis is prevalent in the USA, with nearly 300,000 admissions, 1.5 million days of care, and $2 billion in costs a n n u a l l y a c r o ss a c u t e e p i s o d e s , r e c u r r e n c e s , o r complications.1,2 The COVID-19 pandemic has affected healthcare utilization broadly3,4 and may have impacted patients with diverticulitis through “stay-at-home” orders or provider availability. To date, the short-term impact of the COVID-19 pandemic across the spectrum of diverticular disease has not been described.
emergency department (ED)) and complications (perforation, abscess). Episodes were defined by the highest intensity visit (inpatient highest, outpatient lowest) in a 14-day time period. Care occurring greater than 42 days later was considered a separate episode. In Washington State, a state of emergency was proclaimed on February 28 and non-essential travel and non-emergent medical care prohibited on March 25. Health care restrictions were eased on May 18. We characterized hospital-level burden of diverticulitis before and after COVID-19 “stay-at-home” orders on March 1, 2020. Data are compared using t tests and the chi-square (STATA MP 16.0, College Station, TX).
Methods Consecutive patients who presented to Virginia Mason Medical Center with a diagnosis of diverticulitis between January 1, 2018, and June 12, 2020, were identified. For each patient, burden of disease was quantified in two different ways: by counting encounters in the healthcare system and by estimating “episodes” of diverticulitis. ICD10 codes (Appendix) were used to define diverticulitis-related encounters (outpatient, inpatient, including operations and percutaneous drainage, or
* Vlad V. Simianu [email protected] 1
Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA
2
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
3
Department of Medicine, Virginia Mason Medical Center, Seattle, WA, USA
4
Center for Health Care Improvement Science, Virginia Mason Medical Center, Seattle, WA, USA
Results There were 946 episodes of diverticulitis among 728 unique patients (mean age 63 years, 43% male). Sixteen percent(n = 153) were for complicated disease, and 8%(n = 73) required surgical intervention. With “stay-athome” orders, there was a decrease in diverticulitis episodes from 34 to 20/month(p = 0.004). Episodes reached a low of 10/month in April 2020 before increasing following the easing of restrictions on May 18, 2020 (Fig. 1). Complicated episodes did not change, 16% (142/885) to 20% (12/61), p = 0.46. Prior to March 1, 2020, there was a mean 46
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