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Hartmann's reversal is associated with worse outcomes compared to elective left colectomy: A NSQIP analysis of 36,794 cases

Published:October 15, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.10.026

      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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