A marked difference in cost of care exist across races for patients admitted with diverticulitis.

Shih-Dun Liu; Chibueze Nwaiwu; Andrew Stephen; Daithi Heffernan

Diverticulitis is an acute surgical disease often requiring admission and, at times, may require surgical intervention. In-patient care can be extremely costly. It is becoming recognized that significant racial and ethnic disparities exist with respect to delivery and outcome of surgical care and this may pose differential costs upon patients. We undertook an analysis of the cost of care for patients admitted with diverticulitis across races.

This is a retrospective review of the National In-Patient Sample, of patients aged 18 years and older, who were admitted for diverticulitis. The database was reviewed for demographics including age, sex and race, hospital course, medical comorbidities and outcomes including need for operation, length of stay and mortality. Patients were divided by race – White (W), Black (BL), Hispanic (HI) and Other (OT) – and whether they presented with perforated or non-perforated diverticulitis. SigmaPlot12.5 was used for statistical analysis.

Overall, there were 50, 946 patients with an average age of 64.1 +/- 0.06 years, 44.1% were male and 36.1% presented with perforated diverticulitis. Within the group as a whole, 73.1% were White, 12.4% were Black, and 10.4% were Hispanic. Black patients were significantly less likely to present with perforated diverticulitis (W=37.8%, BL=24.3%, HI=38%, OT=34%; p<0.05 BL vs all others). Among those with non-perforated diverticulitis, Black patients were significantly less likely to undergo operative intervention (W=12.9%; BL=4.9%; HI=11.3%; OT = 8.9%; p< 0.0001). Among those presenting with perforated diverticulitis, White patients were significantly more likely to undergo operative intervention (W=22.4%; BL=18.1%; HI=17.1%; OT=18.2%; p<0.001 White versus all others). Among patients who presented with perforated diverticulitis who did not undergo any operative intervention, HI and OT patients had significantly higher cost of care compared to WH or BL pts (W=$45,297; BL=$45,754; HI=$53,799; OT=$49,578; p<0.001). Among patients with perforated diverticulitis patients who did undergo operative intervention, White patients had the lowest cost of care compared to all other races (WH=$110,507; BL=$138,758; HI=$136,166; OT=$134,015; p<0.001).

Great caution must be exercised in the delivery of care for patients with diverticulitis, given that cost of care discrepancies can have as profound an impact upon quality of life as much as medical or surgical complications.