title: Reversal of Hartmann's procedure: a high-risk operation?
abstract: 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.
authors.affiliation: Department of Surgery, Carolinas Medical Center, Charlotte, NC 28203, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Schmelzer
authors.forename: Gamal
authors.initials: G
authors.lastname: Mostafa
authors.forename: H James
authors.initials: HJ
authors.lastname: Norton
authors.forename: William L
authors.initials: WL
authors.lastname: Newcomb
authors.forename: William W
authors.initials: WW
authors.lastname: Hope
authors.forename: Amy E
authors.initials: AE
authors.lastname: Lincourt
authors.forename: Kent W
authors.initials: KW
authors.lastname: Kercher
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Kuwada
authors.forename: Keith S
authors.initials: KS
authors.lastname: Gersin
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
mesh_terms: 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