Racial Disparity in the Surgical Management of Diverticular Disease

2021 ◽  
pp. 000313482110586
Author(s):  
Warqaa M. Akram ◽  
Nasreen Vohra ◽  
William Irish ◽  
Emmanuel E. Zervos ◽  
Jan Wong
Keyword(s):  
Diverticular Disease ◽  
Racial Disparity ◽  
Acute Diverticulitis ◽  
Binary Logistic Regression ◽  
National Database ◽  
Inclusion Criteria ◽  
Surgical Quality ◽  
Improvement Project ◽  
Surgery Outcomes ◽  
Main Effects

Introduction Although minimally invasive surgery (MIS) has clearly been associated with improved colorectal surgery outcomes, not all populations benefit from this approach. Using a national database, we analyzed both, the trend in the utilization of MIS for diverticulitis and differences in utilization by race. Methods Colon-targeted participant user files (PUFs) from 2012 to 18 were linked to respective PUFs in National Surgical Quality Improvement Project. Patients undergoing colectomy for acute diverticulitis or chronic diverticular disease were included. Surgical approach was stratified by race and year. To adjust for confounding and estimate the association of covariates with approach, data were fit using multivariable binary logistic regression main effects model. Using a joint effects model, we evaluated whether the odds of a particular approach over time was differentially affected by race. Results Of the 46 713 patients meeting inclusion criteria, 83% were white, with 7% black and 10% other. Over the study period, there was a decrease in the rate of open colectomy of about 5% P < .001, and increase in the rate of utilization of laparoscopic and robotic approaches (RC) P < .0001. After adjusting for confounders, black race was associated with open surgery P < .0001. Conclusion There is disparity in the utilization of MIS for diverticulitis. Further research into the reasons for this disparity is critical to ensure known benefits of MIC are realized across all races.

scholarly journals Role of Dietary Habits in the Prevention of Diverticular Disease Complications: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1288
Author(s):  
Marilia Carabotti ◽  
Francesca Falangone ◽  
Rosario Cuomo ◽  
Bruno Annibale
Keyword(s):  
Systematic Review ◽  
Diverticular Disease ◽  
Dietary Habits ◽  
Acute Diverticulitis ◽  
High Quality ◽  
Eligibility Criteria ◽  
Diverticular Bleeding ◽  
Recurrent Diverticulitis ◽  
Increased Risk

Recent evidence showed that dietary habits play a role as risk factors for the development of diverticular complications. This systematic review aims to assess the effect of dietary habits in the prevention of diverticula complications (i.e., acute diverticulitis and diverticula bleeding) in patients with diverticula disease. PubMed and Scopus databases were searched up to 19 January 2021, 330 records were identified, and 8 articles met the eligibility criteria and were subjected to data extraction. The quality of the studies was evaluated by the Newcastle-Ottawa quality assessment form. No study meets the criteria for being a high-quality study. A high intake of fiber was associated to a decreased risk of diverticulitis or hospitalization due to diverticular disease, with a protective effect for fruits and cereal fiber, but not for vegetable fiber; whereas, a high red meat consumption and a generally Western dietary pattern were associated with an increased risk of diverticulitis. Alcohol use seemed to be associated to diverticular bleeding, but not to recurrent diverticulitis or diverticular complications. Further high-quality studies are needed to better define these associations. It is mandatory to ascertain the role of dietary habits for the development of recurrent acute diverticulitis and diverticular bleeding.

scholarly journals Gut Microbiota and Acute Diverticulitis: Role of Probiotics in Management of This Delicate Pathophysiological Balance

2021 ◽  
Vol 11 (4) ◽  
pp. 298
Author(s):  
Andrea Piccioni ◽  
Laura Franza ◽  
Mattia Brigida ◽  
Christian Zanza ◽  
Enrico Torelli ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Diverticular Disease ◽  
Acute Diverticulitis ◽  
Bacterial Species ◽  
Mucosal Inflammation ◽  
Abdominal Symptoms ◽  
Pubmed Database ◽  
Anti Inflammatory ◽  
Key Terms

How can the knowledge of probiotics and their mechanisms of action be translated into clinical practice when treating patients with diverticular disease and acute diverticulitis? Changes in microbiota composition have been observed in patients who were developing acute diverticulitis, with a reduction of taxa with anti-inflammatory activity, such as Clostridium cluster IV, Lactobacilli and Bacteroides. Recent observations supported that a dysbiosis characterised by decreased presence of anti-inflammatory bacterial species might be linked to mucosal inflammation, and a vicious cycle results from a mucosal inflammation driving dysbiosis at the same time. An alteration in gut microbiota can lead to an altered activation of nerve fibres, and subsequent neuronal and muscular dysfunction, thus favoring abdominal symptoms’ development. The possible role of dysbiosis and mucosal inflammation in leading to dysmotility is linked, in turn, to bacterial translocation from the lumen of the diverticulum to perivisceral area. There, a possible activation of Toll-like receptors has been described, with a subsequent inflammatory reaction at the level of the perivisceral tissues. Being aware that bacterial colonisation of diverticula is involved in the pathogenesis of acute diverticulitis, the rationale for the potential role of probiotics in the treatment of this disease becomes clearer. For this review, articles were identified using the electronic PubMed database through a comprehensive search conducted by combining key terms such as “gut microbiota”, “probiotics and gut disease”, “probiotics and acute diverticulitis”, “probiotics and diverticular disease”, “probiotics mechanism of action”. However, the amount of data present on this matter is not sufficient to draw robust conclusions on the efficacy of probiotics for symptoms’ management in diverticular disease.

scholarly journals Measures of speech rhythm and the role of corpus-based word frequency: a multifactorial comparison of Spanish(-English) speakers

2011 ◽  
Vol 11 (2) ◽  
pp. 1 ◽  
Author(s):  
Michael J. Harris ◽  
Stefan Th. Gries
Keyword(s):  
Word Frequency ◽  
Binary Logistic Regression ◽  
Spanish Speakers ◽  
English Speakers ◽  
Vowel Duration ◽  
Mexican Spanish ◽  
Speech Rhythm ◽  
Multiple Metrics ◽  
Main Effects ◽  
The Impact

In this study, we address various measures that have been employed to distinguish between syllable and stress- timed languages. This study differs from all previous ones by (i) exploring and comparing multiple metrics within a quantitative and multifactorial perspective and by (ii) also documenting the impact of corpus-based word frequency. We begin with the basic distinctions of speech rhythms, dealing with the differences between syllable-timed languages and stress-timed languages and several methods that have been used to attempt to distinguish between the two. We then describe how these metrics were used in the current study comparing the speech rhythms of Mexican Spanish speakers and bilingual English/Spanish speakers (speakers born to Mexican parents in California). More specifically, we evaluate how well various metrics of vowel duration variability as well as the so far understudied factor of corpus-based frequency allow to classify speakers as monolingual or bilingual. A binary logistic regression identifies several main effects and interactions. Most importantly, our results call the utility of a particular rhythm metric, the PVI, into question and indicate that corpus data in the form of lemma frequencies interact with two metrics of durational variability, suggesting that durational variability metrics should ideally be studied in conjunction with corpus-based frequency data.

Results of a Surgeon-Directed Quality Improvement Project on Breast Cancer Surgery Outcomes in South-Central Ontario

2014 ◽  
Vol 21 (7) ◽  
pp. 2181-2187 ◽  
Author(s):  
Peter Lovrics ◽  
Nicole Hodgson ◽  
Mary Ann O’Brien ◽  
Lehana Thabane ◽  
Sylvie Cornacchi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Improvement ◽  
Cancer Surgery ◽  
Quality Improvement Project ◽  
Breast Cancer Surgery ◽  
Improvement Project ◽  
South Central ◽  
Surgery Outcomes

Colonic diverticular disease

2020 ◽  
pp. 2960-2966
Author(s):  
Nicolas C. Buchs ◽  
Roel Hompes ◽  
Shazad Q. Ashraf ◽  
Neil J.McC. Mortensen
Keyword(s):  
Diverticular Disease ◽  
Acute Diverticulitis ◽  
Underlying Disease ◽  
Fistula Formation ◽  
Bowel Habit ◽  
Elective Resection ◽  
Sigmoid Carcinoma ◽  
Fibre Diet ◽  
Colonic Diverticula ◽  
Colonic Diverticular Disease

Colonic diverticula are herniations of mucosa through the bowel musculature. They are seen most often in the sigmoid and descending colon, with a prevalence of up to 65% in people over the age of 80 in European populations. They are uncommon in African and Asian countries, where the prevalence is only 0.2%. A lifelong diet deficient in dietary fibre is associated with their development, but it is not known why some diverticula become symptomatic. Diverticula are usually discovered incidentally, but symptoms which are attributable to diverticular disease include colicky abdominal pain and bloating, often accompanied by a change in bowel habit with the passage of broken, pellety stools after considerable straining. All patients with such presentation should be investigated to exclude rectal or sigmoid carcinoma. Treatment is with reassurance that there is no serious underlying disease, a high-fibre diet, and—for patients with pain—antispasmodics such as mebeverine. Elective resection may be indicated in the few patients who have repeated severe attacks. Complications of diverticular disease include diverticulitis, pericolic abscess formation, peritonitis, intestinal obstruction, haemorrhage, and fistula formation. Acute diverticulitis typically presents with pain and tenderness over the left lower abdomen, and the patient may have pyrexia, malaise, anorexia, and nausea. Treatment is with rest, broad-spectrum antibiotics, and analgesia. Resection of the sigmoid colon may be necessary if symptoms fail to resolve or recur, or for patients with complications (peritonitis, fistula, obstruction). Overall, percutaneous drainage, antibiotic treatment, and expectant policies have reduced the need for both acute and elective surgical treatment.

scholarly journals Role of Inflammation in the Pathogenesis of Diverticular Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Antonio Tursi ◽  
Walter Elisei
Keyword(s):  
Diverticular Disease ◽  
Acute Diverticulitis ◽  
Human Colon ◽  
Recurrent Abdominal Pain ◽  
Preliminary Evidence ◽  
Low Grade ◽  
Symptom Persistence ◽  
Uncomplicated Diverticular Disease ◽  
Low Grade Inflammation

Diverticulosis of the colon is the most common condition in Western societies and it is the most common anatomic alteration of the human colon. Recurrent abdominal pain is experienced by about 20% of patients with diverticulosis, but the pathophysiologic mechanisms of its occurrence are not completely understood. In the last years, several fine papers have showed clearly the role of low-grade inflammation both in the occurrence of symptoms in people having diverticulosis, both in symptom persistence following acute diverticulitis, even if the evidence available is not so strong. We do not know yet what the trigger of this low-grade inflammation occurrence is. However, some preliminary evidence found colonic dysbiosis linked to low-grade inflammation and therefore to symptom occurrence in those patients. The aim of this paper is to summarize current evidences about the role of inflammation in symptom occurrence in symptomatic uncomplicated diverticular disease and in symptom persistence after an episode of acute diverticulitis.

scholarly journals Parkinson Disease Associated Differences in Elective Orthopedic Surgery Outcomes: A National Readmissions Database Analysis

2020 ◽  
Vol 10 (4) ◽  
pp. 1577-1586
Author(s):  
Michelle Fullard ◽  
Dylan Thibault ◽  
Hanan Zisling ◽  
James A. Crispo ◽  
Allison Willis
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Length Of Stay ◽  
Index Admission ◽  
Inclusion Criteria ◽  
Database Analysis ◽  
Discharge Disposition ◽  
Orthopedic Procedure ◽  
Surgery Outcomes ◽  
Clinical Conditions

Background: Advances in the treatment of Parkinson’s disease (PD) have allowed for improvements in mortality and quality survival, making the management of comorbid conditions of aging, such as osteoarthritis, crucial. Objective: To determine the extent to which PD impacts hospitalization outcomes after an elective orthopedic procedure. Methods: This retrospective cohort study used data from the National Readmissions Database and included adults ages 40 and above with and without PD. Primary outcomes included length of stay of the index admission, discharge disposition and 30-day readmission. Logistic regression was used to compare the odds of readmission for PD patients compared to non-PD. Clinical conditions associated with readmission were compared between the two groups. Results: A total of 4,781 subjects with PD and 947,475 subjects without PD met inclusion criteria. Length of stay (LOS) during the index admission was longer for PD patients. PD patients were much more likely to be discharged to inpatient post-acute care (49.3% vs 26.2%) while non-PD subjects were more likely to be discharged home with (31.9% [PD] vs 44.8% [non-PD]) or without home health (18.7% [PD] vs 28.9% [non-PD]). A total of 271 PD patients (5.66%) and 28,079 non-PD patients (2.96%) were readmitted within 30 days following surgery. After adjusting for age, sex, socioeconomic status, expected payer, comorbidities, index admission LOS, year and discharge disposition, PD subjects were 31% more likely to be readmitted than non-PD subjects (AOR 1.31, 1.07–1.62). Conclusions: Parkinson’s disease patients were readmitted more often than non-PD patients, although the rate of readmission was still low.

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