AIM:Symptomatic diverticular disease (DD) may be increasing in incidence in western society particularly in younger age groups. This study aimed to describe hospital admission rates and management for DD in Scotland between 2000 and 2010. METHOD:Data were obtained from the Scottish Morbidity Records (SMR01). The study cohort included all patients with a hospital admission and a primary diagnosis of DD of the large intestine (ICD-10 primary code K57). RESULTS:Scottish NHS hospitals reported 90 990 admissions for DD (in 87 314 patients) from 2000 to 2010. The annual number of admissions increased by 55.2% from 6591 in 2000 to 10,228 in 2010, an average annual increase per year of 4.5%. Most of the increase attributable to DD was due to elective day cases (3618 in 2000; 6925 in 2010) a likely consequence of a greater proportion of the population accessing colonoscopy over that time period. There was an 11% increase in inpatient admissions (2973-3303), 60% of these patients being women. Admissions in younger age groups increased proportionally in the later years of the study, and there was an association between DD admissions and greater deprivation. Despite an increase in complicated DD from 22.9% in 2000 to 27.1% in 2010 and a 16.8% increase in emergency inpatient admissions, the rate of surgery fell during the period of study. CONCLUSION:This report supports findings of other population-based studies of western countries indicating that DD is an increasing burden on health service resources, particularly in younger age groups.

Background: Survivors of childhood, adolescent, and young adult cancer are known to be at risk of late effects of their disease and its treatment. Most population-based studies of cancer survivors have reported on second primary cancers and mortality. The aim of this study was to research acute and psychiatric hospital admission rates and length of stay in 5-year survivors of cancer diagnosed before the age of 25 years.Methods: This was a population-based retrospective cohort study using linked national cancer registry, acute hospital discharge, psychiatric hospital, and mortality records. The study population consisted of 5229 individuals who were diagnosed with cancer before the age of 25 years between 1981 and 2003, and who survived at least 5 years after the date of diagnosis of their primary cancer. Indirect standardisation for age and sex was used to calculate standardised bed days and hospitalisation ratios (SBDR and SHR) for both acute and psychiatric hospital admissions, and absolute excess risks (AERs) compared with the general Scottish population.Results: Five-year survivors of cancer, diagnosed before the age of 25 years, are at increased risk of admission to acute hospitals (SHR 2.8; 95% confidence interval 2.7-2.9) and of spending more time in hospital (SBDR 3.7; 3.6-3.7). Corresponding AERs were 6.4 (6.0-6.6) admissions and 64.8 (64.4-66.9) bed days per 100 cancer survivors per year. In contrast, 5-year survivors were not at higher risk of admission to psychiatric hospital (SHR 0.9; 0.8-1.2), and they spent significantly less time as psychiatric in-patients (SBDR 0.4; 0.4-0.4) compared with the whole population.Conclusion: Using routinely collected linked records, our population-based study has demonstrated increased rates of hospitalisation in 5-year survivors of cancer diagnosed before the age of 25 years. Long-term clinical follow-up of survivors of cancer in this age group should focus on the prevention and treatment of the late effects of cancer in those patients at highest risk of hospitalisation.

BACKGROUND:Although population-based studies of patients with Crohn's disease (CD) suggest only a modestly increased mortality, recent data have raised concerns regarding the outcome of CD patients requiring hospitalisation. AIM:To determine the mortality and contributory factors in 1595 patients hospitalised for CD in Scotland between 1998 and 2000. METHODS:The Scottish Morbidity Records database and linked datasets were used to assess longitudinal patient outcome, and to explore associations between 3-year mortality and age, sex, comorbidity, admission type and social deprivation. The standardised mortality ratio (SMR) at 3 years from admission was calculated with reference to the Scottish population. RESULTS:The SMR was 3.31 (95% confidence interval 2.80-3.89). This was increased in all patients, other than those <30 years at presentation, and was highest in patients aged 50-64 years (SMR 4.84 [3.44-6.63]). On multivariate analysis, age >50, admission type, comorbidity, social deprivation and length of admission were significantly associated with mortality. Other than age, admission type was the strongest factor predictive of death. Three-year crude mortality was 0.3% for elective surgical, 8.7% for emergency surgical, 8.3% for elective nonsurgical and 12.7% for emergency nonsurgical admission (P < 0.001). CONCLUSIONS:The study demonstrates high mortality rates in patients hospitalised during 1998-2000 for CD, especially in patients over 50. Elective surgery is associated with lower mortality than emergency surgery or medical therapy. Further study is needed to determine whether these patterns have changed following the introduction of biological treatment.

Introduction Information on the epidemiology and burden of diverticular disease (DD) requiring hospitalisation is limited. The study reviewed DD admissions in Scotland in the last 14 years. Methods The Scottish national record linkage database was used to assess day case and inpatient hospital admissions from April1 1996 to 31 March 2010 for DD (ICD10 K57). Cases selected were Scottish residents with coding of DD as primary diagnosis on the Scottish Morbidity Record (SMR01). Continuous inpatient stays (CIS) were assessed to include intra-department and inter-hospital transfers. Age, gender and length of stay (LOS) associated with DD were compared to admissions for other gastrointestinal problems in the same period. Results Hospital admissions with a primary DD diagnosis increased by 107% over the 14 years (5284 in 1996–1997 to 10,935 in 2009–2010), compared with a 20% increase in admissions for general primary gastrointestinal diagnoses (excluding DD) during the same period. The proportion of DD admissions by age remained largely consistent, but over the 14 years, more women were admitted than men (61% vs 39%), most notably in those over 50 years (65,571♀ vs 39,558♂). Mean LOS for all cases decreased from 6.4 to 3.2 days and mean inpatient LOS from 10.6 to 8.8 days. The rise in DD admissions was almost entirely due to admissions ≤1 day (2562 in 1996–1997, 7893 in 2009–2010). Of these, 74% related to diagnostic colonoscopy/sigmoidoscopy (2158 in 1996–1997, 6089 in 2009–2010). Patients were most often admitted under General Surgery (71%), Gastroenterology (16%) or General Medicine (10%). Of 7893 admissions ≤1 day in 2009–2010, 6089 were for colonoscopy/sigmoidoscopy, and 91% (7186) had an admission reason recorded. Acute medical care or treatment was coded in 69% (3822) of colonoscopy episodes and 67% (1100) of other episodes, with investigation only coded in 31% (1711) and 33% (553), respectively. Only 2.7% of admissions ≤1 day were emergency, with 15% undergoing colonoscopy. Conclusion Admissions for DD in Scotland increased considerably between 1996 and 2010. Most of this rise is attributable to admissions ≤1 day for colonoscopy/sigmoidoscopy, but 26% of the rise in admissions ≤1 day was attributable to non-diagnostic admissions where acute treatment was undertaken, adding to the healthcare burden.