Impact of Changing Guidelines on Elective Resection of Uncomplicated Diverticulitis in the United States

Abstract

Introduction

The incidence of diverticulitis has increased in recent years. Management strategies have shifted from routine elective colectomy after two episodes of uncomplicated diverticulitis to more individualized decision-making.

Objective

To evaluate the impact of updated management guidelines on trends and outcomes of elective colectomy for uncomplicated diverticulitis.

Methods

A retrospective cohort study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program (2012–2019). Patients undergoing elective colectomy for uncomplicated diverticulitis were included. Exclusion criteria were complicated diverticulitis, emergent surgery, malignancy on final pathology, and ASA score of 5 or unknown. Emergent cases were analyzed only for temporal trends.

Results

From 2012 to 2019, elective colectomies for uncomplicated diverticulitis increased from 2,326 (96.7% elective) to 3,740 (98.9% elective) (p < 0.001). After excluding emergent cases, 25,045 patients were analyzed. Overall morbidity decreased from 16.4% to 10.7% (p < 0.001), and serious morbidity from 7.4% to 6.5% (p = 0.005). Other improvements included reductions in reoperation (4.2% to 3.5%), anastomotic leak (3.5% to 2.8%), wound infection (7.7% to 2.9%), transfusion (2.8% to 2.3%), shock/sepsis (3.1% to 2.4%), ileus (7.2% to 5.4%), and median length of stay (4 to 3 days). Operative time increased slightly (172 to 181 minutes, p = 0.002). Ostomy and mortality rates remained unchanged.

Conclusion

Despite guideline changes encouraging individualized management, elective colectomies for uncomplicated diverticulitis are increasing, with significantly improved postoperative outcomes, possibly due to better patient selection and surgical care.

Keywords

uncomplicated diverticulitis - elective colectomy - diverticulitis management guidelines

Meetings

Accepted for a poster presentation at the American Society of Colon and Rectal Surgeons Annual 2025 meeting, San Diego, CA, May 10–1, 2025, and Chesapeake Colorectal Society, Bethesda, MD, April 5, 2025.

Author Contributions

TKF wrote the original draft of the manuscript. TKF, SLG, and VJO conceptualized the project. MS contributed data curation, formal analysis, and project administration. VJO supervised the project. All other authors contributed to reviewing and editing the manuscript

Publikationsverlauf

Eingereicht: 01. Juli 2025

Angenommen: 01. Oktober 2025

Artikel online veröffentlicht:
29. Dezember 2025

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