A population-based analysis of acute diverticulitis emergent presentation patterns and surgical interventions: A natural experiment during the COVID-19 pandemic

Acute colonic diverticulitis is a common diagnosis in adult patients, resulting in frequent emergency department visits and hospital admissions. Patients with diverticulitis are often managed with antibiotics alone, however, remain at lifetime risk for recurrent episodes that may be complicated by bowel perforation requiring emergency surgery (colon resection) with possible stoma formation (colostomy). To avoid complications associated with emergency surgery, patients who are deemed high risk for recurrence are recommended to undergo a prophylactic scheduled colon resection. The COVID-19 pandemic has resulted in a large backlog and extended wait times for non-cancer scheduled surgeries. Patients are therefore at risk of recurrent attacks requiring emergency surgery while awaiting scheduled colon resection. It is hypothesized that the COVID-19 pandemic related delays in scheduled colon resections have resulted in more severe episodes of diverticulitis and increased rates of emergency surgery with stoma formation. I propose a large population-based study, inclusive of all adult residents of Ontario to (1) quantify the backlog of scheduled colon resections for diverticulitis in Ontario and (2) characterize disease severity and emergency surgical interventions in Ontario occurring during the COVID-19 period (Mar 2020-Dec 2022) compared to the pre-pandemic baseline (Jan 2017-Feb 2020) to better understand how the pandemic has impacted disease trajectory and resultant surgical management. This comprehensive analysis will inform provincial recovery strategies to address the surgical backlog in Ontario and allow for appropriate prioritization of scheduled colon resections for diverticulitis to mitigate potential complications resulting from delays in scheduled surgery.