Highlights
- •The 2016–2019 ACS-NSQIP datasets were queried to compare Hartmann's reversal (HR) and elective left colectomy (LC) outcomes.
- •HR is associated with longer operative time and higher rates of open operation and concurrent diverting ileostomy than LC.
- •HR is associated with longer hospital stay, higher reoperation rate, and higher rate of postoperative complications than LC.
- •Optimization of modifiable risk factors and adequate discourse of expectations may help reduce adverse outcomes.
Abstract
Background
Hartmann's reversal (HR) is associated with significant technical difficulty and morbidity.
Using the ACS-NSQIP database, we assessed the outcomes of HR as compared to elective
left colectomy (LC).
Methods
The 2016–2019 ACS-NSQIP datasets were queried to identify patients undergoing HR and
elective LC. Patients’ demographics, comorbidities, and short-term surgical outcomes
were evaluated using both univariable and multivariable methods.
Results
The study included 7,632 HR cases and 29,162 LC cases. The HR group had more patients
with ASA grade III (50% vs. 42.4%). HR had more open-operative cases (69.4 vs. 18.5%)
and longer mean operative times (213 vs. 191 min) than LC. Postoperatively, the HR
group had a longer mean hospital stay (5.5 vs. 4.1 days) and higher complication rate
(18.3% vs. 10.3%). HR was associated with increased odds of having a concurrent ileostomy
(OR 2.11), deep space/organ infection (OR 1.55), and at least one complication (OR
1.56).
Conclusion
HR is a more challenging operation with patients who fared worse than their LC counterparts.
Consideration should be given to alternatives of the index Hartmann's procedure.
Keywords
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Article info
Publication history
Published online: October 15, 2022
Accepted:
October 12,
2022
Received in revised form:
August 21,
2022
Received:
March 24,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
