SA205 - Making a Difficult Decision Easy: Patient Reported Outcome Measures in Recurrent Diverticulitis

Purpose/Background: Diverticular disease is a major public health concern affecting 25% of adult people in the developed world. With guidelines for colectomy for recurrent diverticulitis recommending a more patient-centered approach, there is a lack of clarity on who will benefit from elective colectomy. Patient reported outcome measures (PROMs) provide information about the impact of healthcare conditions on quality of life for patients, but their use in clinical decision-making is still being explored. The DV-QOL is a diverticulitis-specific PROM which may be useful in determining who will benefit from elective colectomy for recurrent diverticulitis. It has four sub-domains that address physical symptoms, patient concerns, emotions, and patient behavior. We hypothesized that higher DV-QOL scores (indicating more severe disease burden) would be associated with increased likelihood of electing to undergo colectomy for recurrent diverticulitis.

Methods/Interventions: This was an observational study of patients seen at a tertiary care Colorectal Surgery Clinic for recurrent diverticulitis from March 2021 - August 2023. All patients completed a DV-QOL within 3 weeks of their clinic visit. Exclusion criteria included ICD-10 diagnoses of active malignancy, IBD/IBS, history of solid organ transplant, or active colonic fistula/obstruction/stricture/large abscess (> 5 cm). The primary outcome was decision to proceed with elective colectomy vs. continued observation. Secondary outcomes included recurrent episodes of diverticulitis, healthcare utilization within 6 months of the clinic visit, and urgent/emergent surgeries required for diverticulitis. Statistical analysis was completed with STATA version 17.0. Simple logistic regression and one-sided t-tests were used to evaluate DV-QOL scores between treatment groups.

Results/Outcomes: There were 244 patients who were seen in clinic with a diagnosis of diverticulitis who completed a DV-QOL survey. Of these, 70 patients were included in the study based on our inclusion/exclusion criteria. 48 (68.6%) elected for no surgical intervention and 22 (31.4%) had surgery planned or completed during the study period (19 completed resections, 3 scheduled for future dates). The mean overall DV-QOL scores were 4.59 (SD 1.78) for those who elected for nonoperative management and 5.30 (SD 1.20) for those who elected to undergo elective colonic resection (p = 0.054). An adjusted analysis showed an odds ratio of 1.31 (CI 0.94-1.84, p = 0.11) for electing surgical management with higher baseline DV-QOL scores. There were no statistically significant differences detected between the two groups in the DV-QOL sub-categories of physical symptoms, concerns, and emotions. However, in the sub-category of behavior, those who elected surgical management had higher scores by a mean value of 0.89 (p-value 0.04).

Conclusion/Discussion: We observed significantly higher baseline DV-QOL scores in the subcategory of behavior among patients who chose to pursue elective colectomy after consultation for recurrent diverticulitis. This domain includes wearing different clothing, missing work, avoiding social engagements, and losing sleep. These findings indicate the DV-QOL, especially the sub category of behavior can be a useful tool to gauge the impact of diverticulitis on quality of life and that providers should focus on eliciting information regarding the impact of diverticulitis on a patients behavior when counseling them about their treatment options.