title: Factors influencing postoperative adverse events after Hartmann's reversal.
abstract: OBJECTIVE
  The study was performed to evaluate factors influencing postoperative adverse events after Hartmann's reversal (HR).
  
  
  METHODS
  This was a retrospective study of unselected patients who underwent HR after the Hartmann's procedure (HP) for left colonic perforation with peritonitis at a single institution. Data were retrieved from an Institutional Review Board-approved database. The study end-point was postoperative adverse events, which included mortality, complications, reoperations and 30-day readmission. Lag time was defined as the time from HP to HR. The results are expressed as mean±SD.
  
  
  RESULTS
  From 1997 to 2007, 204 (39.1%) of all patients who underwent the HP [60±16 years of age; 58% men; body mass index (BMI) 27.6±5.7; 2% were American Society of Anesthesiology (ASA) 1, 50.2% were ASA 2, 39.9% were ASA 3 and 7.9% were ASA 4) underwent HR at an interval of 158±107 days. There were 24 laparoscopic and 180 open HRs, with no deaths. The operating time was 167±64 min, estimated blood loss was 245±283 ml and the 30-day readmission rate was 4.9%. Eleven (5.4%) patients developed 14 (6.8%) complications and five (2.4%) of these patients required a new stoma at the time of HR or later. On multivariate analysis controlling for confounders, chronic renal failure requiring dialysis (OR=21.0; 95% CI: 1.5-284; P=0.02) was significantly associated with increased adverse events.
  
  
  CONCLUSIONS
  The study showed that chronic renal failure requiring dialysis was the only independent predictor of postoperative adverse event rates following HR.
authors.affiliation: Department of Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
authors.forename: D
authors.initials: D
authors.lastname: Okolica
authors.forename: M
authors.initials: M
authors.lastname: Bishawi
authors.forename: J R
authors.initials: JR
authors.lastname: Karas
authors.forename: J F
authors.initials: JF
authors.lastname: Reed
authors.forename: F
authors.initials: F
authors.lastname: Hussain
authors.forename: R
authors.initials: R
authors.lastname: Bergamaschi
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000379:methods; D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003125:Colostomy / Q000379:methods; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000401:mortality / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data; D010538:Peritonitis / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012007:Rectum / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors