Application of a Tertiary Referral Scoring System to Predict Nonreversal of Hartmann's Procedure for Diverticulitis in a Community Hospital

Abstract

Riansuwan et al. at Cleveland Clinic developed a scoring system to quantify the risk of Hartmann's nonreversal based on age, preoperative transfusion, pulmonary comorbidity, American Society of Anesthesiologists score, perforation, and anticoagulation. Our study validates the scoring system in a community hospital setting. Patients undergoing Hartmann's procedure for diverticulitis (2006 to June 2009) were identified from our hospital's database. Two groups were formed based on Hartmann's reversal within 1 year and those with nonreversal. An independent-sample t test and logistic regression using score and nine other variables as predictors of Hartmann's non-reversal were run. Sixty-three of 93 patients (67.7%) had a Hartmann's reversal. Higher scores and higher mean age were seen in the nonreversal group (15.5 ± 3.0 vs 12.1 ± 2.5 and 73 ± 15 vs 63 ± 14 years, respectively). Patients with scores 18 or above were not reversed; 43 of 49 patients (88%) with scores of 13 or less were reversed. Logistic regression confirmed that the only predictive variable for nonreversal is a higher score. The scoring system is predictive of nonreversibility of Hartmann's procedure for acute diverticulitis. This will be useful in allowing surgeons to strategize accurately and to counsel patients realistically. Higher scores may allow both the surgeon and patient to have a low threshold for exploring alternatives to Hartmann's procedure.

Reversal of Hartmann's procedure: a single‐centre experience of 533 consecutive cases

“…In agreement with previously published results , ASA Grade I or II patients were more likely to undergo reconstruction. Also consistent with the ASA grade, patients in our study with a low Charlson index (< 6) had a higher rate of reconstruction.…”

“…The mean age of the patients who underwent intestinal reconstruction surgery was lower than that of those who did not receive HP reversal surgery (58.9 years vs 75.1 years), which is in agreement with most published studies . The statistical analysis has disclosed a significant change in the trend of HP reversal rate in our patients, at the age of 69 years.…”

“…However, the difference was not significant. Previous studies have also suggested that gender is important . In our view it is unlikely that pelvis width was a factor that influenced the technical difficulty of the reconstruction because the majority of patients who were restored had a rectal stump at or above the level of the sacral promontory.…”

“… and Vaid et al . . We suggest that patients who did not require blood transfusion had fewer comorbidities or a benign pathology, or a technically easier procedure.…”

“…However, the factors related to the decision to restore intestinal continuity are not well established. Some authors have suggested that a predictive score, incorporating a range of factors, might contribute to the decision making process .…”