Clinical Scorecard: Management of Diverticulitis Patients Amid the COVID-19 Pandemic in Germany: A Retrospective Nationwide Cohort Analysis

At a Glance

Key Highlights

• COVID-19 lockdowns in Germany led to postponement of non-urgent elective surgeries and reduced patient consultations.
• During the pandemic, fewer emergency visits occurred but CT scan usage increased for acute abdominal pain including suspected diverticulitis.
• Complicated diverticulitis cases increased during the pandemic with higher severity and mortality reported in some studies.

Guideline-Based Recommendations

Diagnosis

• Use ICD-10-GM codes (K57) to identify diverticulitis cases excluding small intestine diverticulitis (K57.0, K57.1).
• Employ CT imaging for suspected acute diverticulitis especially during pandemic periods with increased case severity.

Management

• Postpone elective surgeries for uncomplicated diverticulitis safely during pandemic lockdowns with triage to prioritize complicated cases.
• Emergency surgical interventions should be maintained for complicated diverticulitis cases to prevent adverse outcomes.

Monitoring & Follow-up

• Monitor hospital admission rates and treatment modalities during pandemic waves to adjust resource allocation.
• Track in-hospital course including emergency admissions and surgical complexity to assess impact of pandemic on diverticulitis care.

Risks

• Increased risk of complicated diverticulitis including abscess and perforation during COVID-19 infection or delayed presentation.
• Potential higher all-cause mortality associated with complicated diverticulitis during pandemic periods.

Patient & Prescribing Data

Nationwide cohort of 991,579 patients admitted for diverticulitis in Germany from 2012 to 2021

One third of patients with complicated diverticulitis postponed surgery safely compared to 83% with uncomplicated diverticulitis, highlighting need for triage during elective surgery postponements.

Clinical Best Practices

• Implement triage protocols to differentiate complicated versus uncomplicated diverticulitis for surgical prioritization during healthcare resource constraints.
• Maintain emergency surgical capacity for complicated diverticulitis despite pandemic-related restrictions.
• Use comprehensive nationwide billing and procedural data to monitor trends and outcomes in diverticulitis management during public health crises.

References

• German Federal Statistical Office
• German Federal Ministry of Health Coronavirus Chronology