Early Operation Has Advantage Over Interval Operation for Complicated Diverticulitis

Esnaola GR, Schultz KS, Moore MS, et al. Cost-Effectiveness Analysis of Early Operation vs Percutaneous Drain Placement with Interval Operation for Complicated Diverticulitis with Abscess Formation. J Am Coll Surg. November 2025.

This study examines when to perform non-emergent colectomy for patients with complicated diverticulitis and an abscess. Early surgery carries concerns about increased stoma formation and a longer hospital stay, whereas delaying surgery after percutaneous drainage can prolong the overall course of care and exposes patients to recurrent flares.

To clarify these trade-offs, the authors built a decision-analytic model using published data and Merative Marketscan claims data to compare outcomes and costs between early colectomy (48 hours to 30 days) and interval colectomy (31 to 120 days after drainage).

The model showed that early operation was both less expensive and more effective treatment in terms of quality adjusted life years (QALYs). On average, it reduced costs by $8,852 per patient and provided an additional 0.57 QALYs compared with interval surgery. These findings held up in probabilistic sensitivity analysis, with early surgery favored in 96% of simulations. The analysis also identified a key threshold: early colectomy remained cost-effective as long as percutaneous drainage produced at least a 0.044 reduction in QALYs.

Overall, the results suggest that early colectomy should be considered the preferred strategy for many patients with diverticular abscess, as it appears to deliver better outcomes at lower cost. Still, interval surgery may be appropriate for patients who experience little quality-of-life impact from temporary drainage or who strongly prefer to delay intervention. 

Ultimately, operative timing should be individualized through shared decision-making.