Reversal of Hartmann's procedure: a high-risk operation?
BACKGROUND
Patients who undergo Hartmann's procedure often do not have their colostomy closed based on the perceived risk of the operation. This study evaluated the outcome of reversal of Hartmann's procedure based on preoperative risk factors.


METHODS
We retrospectively reviewed adult patients who underwent reversal of Hartmann's procedure at our tertiary referral institution. Patient outcomes were compared based on identified risk factors (age >60 years, American Society of Anesthesiologists [ASA] score >2, and >2 preoperative comorbidities).


RESULTS
One-hundred thirteen patients were included. Forty-four patients (39%) had an ASA score of >or=3. The mean hospital duration of stay was 6.8 days. There were 28 (25%) postoperative complications and no mortality. Patients >60 years old had significantly longer LOS compared with the rest of the group (P = .02). There were no differences in outcomes between groups based on ASA score or the presence of multiple preoperative comorbidities. An albumin level of <3.5 was the only significant predictor of postoperative complications (P = .04).


CONCLUSIONS
The reversal of Hartmann's operation appears to be a safe operation with acceptable morbidity rates and can be considered in patients, including those with significant operative risk factors.
Schmelzer
Thomas M
TM
Department of Surgery, Carolinas Medical Center, Charlotte, NC 28203, USA.
Mostafa
Gamal
G
Norton
H James
HJ
Newcomb
William L
WL
Hope
William W
WW
Lincourt
Amy E
AE
Kercher
Kent W
KW
Kuwada
Timothy S
TS
Gersin
Keith S
KS
Heniford
B Todd
BT
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000453:epidemiology* / Q000601:surgery*; D003125:Colostomy / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors