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Erschienen in:
01.11.2005 | Original Contribution
Hartmann’s Reversal Is Associated With High Postoperative Adverse Events
Erschienen in: Diseases of the Colon & Rectum | Ausgabe 11/2005
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The aim of this study was to ascertain the prevalence and pattern of surgical and medical adverse events in patients undergoing Hartmann’s reversal for diverticular disease. A comparison of postoperative outcomes is made between Hartmann’s reversal and primary resection and anastomosis.
METHODS
Data were collected from patients who underwent successful Hartmann’s reversal (Group 1, n = 121) and primary resection and anastomosis (Group 2, n = 731) for diverticular disease in a single center from January 1981 to May 2003. Multivariate logistic regression was used to compare early postoperative mortality, medical and surgical complications and readmission rates between the two groups.
RESULTS
Hartmann’s reversal was associated with a higher prevalence of surgical or medical complications compared with primary resection and anastomosis (43.8 percent and 9.1 percent for Hartmann’s reversal vs. 26.0 percent and 4.8 percent for primary resection and anastomosis). There was no difference in the readmission rates (7.2 percent vs. 7.6 percent, respectively, P = 0.88) or early postoperative mortality (1.7 percent vs. 0.7 percent, P = 0.25) between Hartmann’s reversal and primary resection and anastomosis. The need for reoperation, prolonged ileus, respiratory tract infections, and renal failure were more common adverse events in the Hartmann’s reversal group (P < 0.01). Having controlled for the number of comorbid conditions, extent of diverticular disease, severity of peritoneal contamination (Mannheim Peritonitis Index), and operative urgency, patients who underwent Hartmann’s reversal were 2.1 times more likely to have adverse surgical events during their postoperative period (95 percent confidence interval for odds ratio = 1.3–3.3).
CONCLUSIONS
Hartmann’s reversal is a complex surgical procedure that is associated with a high prevalence of postoperative adverse events in comparison with primary resection and anastomosis. To minimize the prevalence of such adverse events, patients who undergo Hartmann’s reversal need careful preoperative evaluation and close monitoring in their postoperative period.