Identification of risk factors for morbidity and mortality after Hartmann’s reversal surgery – a retrospective study from two French centers

Abstract

Hartmann's reversal procedures are often fraught with complications or failure to recover. This being a fact, it is often difficult to select patients with the optimal indications for a reversal. The postrecovery morbidity and mortality rates in the literature are heterogeneous between 0.8 and 44%. The identification of predictive risk factors of failure of such interventions would therefore be very useful to help the practitioner in his approach. Given these elements, it was important to us to analyze the practice of two French university hospitals in order to highlight such risk factors and to allow surgeons to select the best therapeutic strategy. We performed a bicentric observational retrospective study between 2010 and 2015 that studied the characteristics of patients who had undergone Hartmann surgery and were subsequently reestablished. The aim of the study was to identify factors influencing morbidity and postoperative mortality of Hartmann's reversal. Primary outcome was complications within the first 90 postoperative days. 240 patients were studied of which 60.4% were men. The mean age was 69.48 years. The median time to reversal was 8 months. 79.17% of patients were operated as emergency cases where the indication was a diverticular complication (39.17%). Seventy patients (29.2%) underwent a reversal and approximately 43% of these had complications within the first 90 postoperative days. The mean age of these seventy patients was 61.3 years old and 65.7% were males. None of them benefited from a reversal in the first three months. We identified some risk factors for morbidity such as pre-operative low albuminemia (p = 0.005) and moderate renal impairment (p = 0.019). However, chronic corticosteroid use (p = 0.004), moderate renal insufficiency (p = 0.014) and coronary artery disease (p = 0.014) seem to favour the development of anastomotic fistula, which is itself, a risk factor for mortality (p = 0.007). Our study highlights an important rate of complications including significant anastomotic fistula after Hartmann's reversal. Precarious nutritional status and cardiovascular comorbidities should clearly lead us to reconsider the surgical indication for continuity restoration. Currently, Hartmann's interventions are predominantly used as an emergency procedure due to general precarious conditions, such as septic shock but also in planned situations for elderly or frail patients with several comorbidities. Complicated diverticulitis and perforation or obstruction of colorectal cancers are the two major indications of this kind of surgery 1,2. Hartmann's reversal has been linked to high rates of complications. The

Correlation between ASA Grade with reversal of Hartmann’s procedure – a retrospective study

“…This study involved the selection of 118 consecutive patients who underwent Hartmann’s procedure to measure the reversal rate and mortality rate and assess the correlation between demographic data, ASA grade, length of hospital stay, and the reversal rate of Hartmann’s procedure. The most common indication for Hartmann’s procedure in our study was diverticular complications (60%), similar to the studies conducted by Hallam et al [ 19 ] and Christou et al [ 20 ], while the most common indication for Hartmann’s procedure in the study conducted by Zarnescu et al [ 21 ] was colorectal cancer.…”

“…In this study, the reversal rate of Hartmann’s procedure was assessed. 34.9% of the patients underwent a successful reversal, which is higher to previously reported data by Christou et al [ 20 ], where only seventy patients (29.2%) underwent a reversal. A higher percentage was reported in the study conducted by Hallam et al [ 19 ], who reported that the reversal of Hartmann’s rate was 47%.…”

Is Closure of Hartmann’s Colostomy a Safe Operation?

“…4 Hartmann's procedure is a surgical method used not only in urgent surgery or damage control surgery, but also in patients with comorbidities to reduce operation time and to prevent complications due to anastomosis. 5 Although it is preferred to attempt primary anastomosis in colon resections as often as possible, since it will eliminate the need for surgery, the presence of panperitonitis or patient comorbidities may make it necessary to apply Hartmann's procedure, especially in emergency conditions and in cases where preoperative preparation is not sufficient. However, ostomy closure is a challenging decision for surgeons, due to the frequency of postoperative early complications in patients undergoing Hartmann's procedure.…”

“…The frequency of complications varies widely from 0.8% to 40% from centre to centre. 5 This suggests that greater success rates are possible when using Hartmann's procedure or closure, with lower complication rates, but the variables which may affect success should be identified. The aim of this study was to evaluate whether this operation is safe and to reveal the factors associated with complications, based on a population of patients who underwent Hartmann's procedure in our clinic or another health institution and who had the Hartmann's closure in our clinic.…”

Principais complicações da reconstrução do trato intestinal após colostomia à Hartmann

“…Centro Universitário Tocantinense Presidente Antônio Carlos (UNITPAC), Araguaína -TO 8. Universidade Maria Auxiliadora (UMAX), Asunción -Paraguay 9.…”