Article

Factors influencing postoperative adverse events after Hartmann's reversal

Department of Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
Colorectal Disease (Impact Factor: 2.02). 03/2011; 14(3):369-73. DOI: 10.1111/j.1463-1318.2011.02629.x
Source: PubMed

ABSTRACT The study was performed to evaluate factors influencing postoperative adverse events after Hartmann's reversal (HR).
This was a retrospective study of unselected patients who underwent HR after the Hartmann's procedure (HP) for left colonic perforation with peritonitis at a single institution. Data were retrieved from an Institutional Review Board-approved database. The study end-point was postoperative adverse events, which included mortality, complications, reoperations and 30-day readmission. Lag time was defined as the time from HP to HR. The results are expressed as mean±SD.
From 1997 to 2007, 204 (39.1%) of all patients who underwent the HP [60±16 years of age; 58% men; body mass index (BMI) 27.6±5.7; 2% were American Society of Anesthesiology (ASA) 1, 50.2% were ASA 2, 39.9% were ASA 3 and 7.9% were ASA 4) underwent HR at an interval of 158±107 days. There were 24 laparoscopic and 180 open HRs, with no deaths. The operating time was 167±64 min, estimated blood loss was 245±283 ml and the 30-day readmission rate was 4.9%. Eleven (5.4%) patients developed 14 (6.8%) complications and five (2.4%) of these patients required a new stoma at the time of HR or later. On multivariate analysis controlling for confounders, chronic renal failure requiring dialysis (OR=21.0; 95% CI: 1.5-284; P=0.02) was significantly associated with increased adverse events.
The study showed that chronic renal failure requiring dialysis was the only independent predictor of postoperative adverse event rates following HR.

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