Constipation is not associated with colonic diverticula: a multicenter study in Japan.

BACKGROUND: The association of diverticula with bowel habits is unclear. We therefore analyzed the association between diverticula and bowel habits in over 1000 Japanese individuals. METHODS: Japanese subjects who underwent total colonoscopies at seven centers in Japan from June to September 2013 were analyzed. Bowel habits were evaluated using the Gastrointestinal Symptom Rating Scale, and stool form was assessed using a part of the Bristol Scale and Rome ΙΙΙ criteria. Diverticula were diagnosed by colonoscopy with a transparent soft-short hood. KEY RESULTS: The study evaluated 1066 subjects, 648 males and 418 females (ratio, 1.55 : 1), of mean age 63.9 ± 13.0 years. After adjusting for age and sex, the presence of constipation was associated with a significantly reduced likelihood of diverticula (odds ratio [OR] = 0.70, 95% confidence interval [CI] 0.52-0.93). When assessed according to the location of diverticula, the presence of constipation was associated with a significantly decreased likelihood of left-sided (OR = 0.39, 95% CI 0.16-0.93), but not right-sided (OR = 1.10, 95% CI 0.48-2.53), diverticula. Furthermore, stool form was unrelated with the presence or absence of diverticula. CONCLUSIONS & INFERENCES: The wide-spread hypothesis that constipation was associated with colonic diverticula was not supported. Rather, we found that the absence of diverticula was associated with constipation, suggesting the need to reassess the etiology of colonic diverticula.

Determinants of hospital cost and length of stay for patients undergoing electrophysiologic testing.

To assess the effects of various clinical factors in determining the cost and length of stay in patients undergoing electrophysiologic testing for cardiac arrhythmias, the hospital cost and length of stay data were reviewed in 222 consecutive inpatients who underwent electrophysiologic testing from January 1 to December 31, 1984. Admissions were classified as: primarily for treatment of arrhythmias (171 patients); primarily for treatment of arrhythmias but with serious concurrent illnesses that prolonged hospitalization (43 patients); or primarily for nonarrhythmic problems with electrophysiologic study an incidental part of hospitalization (8 patients). Based on allowable length of stay for the applicable DRGs, actual hospitalizations exceeded Medicare allowable length of stay by 50 to 500%. Retrospective review of hospital charts indicated that 3 clinical factors serve as effective markers in determining length of stay: need for amiodarone, induction of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF), and presence of serious other medical problems that require stabilization before electrophysiologic testing. Our data indicate that 3 classes of patients can be identified: I. DRG A (45%)--those who did not have sustained VT or VF induced, did not require amiodarone and had no serious concurrent illnesses. The mean length of stay was 7.1 days. II. DRG B patients (21%)--those who had sustained VT or VF induced, but did not require amiodarone and had no serious concurrent illnesses. The mean length of stay was 13.7 days. III. DRG C patients (34%)--those who either had a serious concurrent illness or required amiodarone. The mean length of stay was 19.7 days. This classification schema might allow a more appropriate system for determining reimbursement.