Epidemiology and Management of Zenker Diverticulum in a Low-Threshold Single-payer Health Care System.

Abstract

IMPORTANCE:

The incidence of Zenker diverticulum has been established; previous estimates have been extrapolated from small institutional cohorts.

OBJECTIVE:

To describe the population-wide incidence of Zenker diverticulum over a 20-year period and characterize management strategies across specialties and treatment settings.

DESIGN, SETTING, AND PARTICIPANTS:

This retrospective national cohort study was conducted from January 1, 1996, through December 31, 2015, and reviewed patient records from the Care Register for Healthcare in Finland, from which patients with Zenker diverticulum were identified. The data were analyzed in October 2021.

EXPOSURES:

Zenker diverticulum.

MAIN OUTCOME AND MEASURE:

The incidence of Zenker diverticulum per 100 000 person-years.

RESULTS:

A total of 2736 patients (median [IQR] age at diagnosis 72.0 [19-106] years; 1278 women [46.7%]) were identified, making the annual incidence of Zenker diverticulum in Finland 2.9/100 000 person-years. Men had higher incidence (3.7/100 000 person-years) compared with women (2.3/100 000 person-years), with an incidence rate ratio of 1.61 (95% CI, 1.48-1.76; P < .001). Within the study population, 1044 patients (38.2%) underwent surgical treatment and 227 (8.3%) underwent 2 or more surgeries. The choice of initial operative approach depended on the medical specialty (Cramer V = 0.41) and on specific catchment area (Cramer V = 0.41). Overall, endoscopic approaches for initial operations were most popular.

CONCLUSIONS AND RELEVANCE:

The cohort study results found that the incidence of Zenker diverticulum was 2.9/100 000 person-years. Most patients with Zenker diverticulum did not undergo definitive therapy. Some hospital districts and some medical specialties were more likely to opt for conservative treatment than others. The choice of operative approach depended more on physician-level factors rather than patient profiles.

• Authors: Sandra Uoti, Saana E-M Andersson, Eric Robinson, Jari Räsänen, Ville Kytö, Ilkka Ilonen
• Journal: JAMA otolaryngology-- head & neck surgery (JAMA Otolaryngol Head Neck Surg) Vol. 148 Issue 3 Pg. 235-242 (Mar 01 2022) ISSN: 2168-619X [Electronic] United States
• PMID: 34913965 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Cohort Studies
• Delivery of Health Care
• Female
• Finland (epidemiology)
• Humans
• Male
• Retrospective Studies
• Treatment Outcome
• Zenker Diverticulum (epidemiology, surgery)