Emergency Hartmann's procedure: morbidity, mortality and reversal rates among Asians.
BACKGROUND
Hartmann's procedure and its reversal are associated with high cumulative morbidity rates. We assessed the outcomes of emergency Hartmann's procedures and permanent stoma rates among Asians.


METHODS
A retrospective review of all emergency Hartmann's procedure performed from 1996 to 2001 was performed.


RESULTS
Emergency Hartmann's procedure was performed in 98 patients with a median age of 68 years. These included 58 patients with cancer and 18 with diverticulitis; 77 patients had pre-existing comorbidities. The mortality and morbidity rates were 19% and 65%, respectively. Mortality was impacted by pre-existing respiratory or cardiac disease, age and ASA grade. Likewise, morbidity was significantly increased in the presence of comorbidities, including hypertension and cardiac disease, and age. On multivariate analysis, only age (p=0.003, OR=1.171) and respiratory disease (p=0.029, OR=11.05) affected mortality rates whilst hypertension (p=0.011, OR=5.85) and cardiac disease (p=0.044, OR=5.46) affected morbidity rates. Re-anastomosis was performed in 70 patients, and in 28 of these patients (40%) bowel continuity was re-established after a median of 9 months with a 7% morbidity rate. Reversibility was only related to patient age (p=0.011).


CONCLUSIONS
Hartmann's procedure is valid among Asians, and its mortality and morbidity rates are related to patients' pre-existing health conditions. The predominant cause is colorectal cancer and permanent stoma rates are related to patient age.
Department of General Surgery, Tan Tock Seng Hospital, Singapore. quormeng@gmail.com
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D003108:Colonic Diseases / Q000401:mortality / Q000601:surgery*; D003125:Colostomy / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology