title: Application of a tertiary referral scoring system to predict nonreversal of Hartmann's procedure for diverticulitis in a community hospital.
abstract: Riansuwan et al. at Cleveland Clinic developed a scoring system to quantify the risk of Hartmann's nonreversal based on age, preoperative transfusion, pulmonary comorbidity, American Society of Anesthesiologists score, perforation, and anticoagulation. Our study validates the scoring  system in a community hospital setting. Patients undergoing Hartmann's procedure for diverticulitis (2006 to June 2009) were identified from our hospital's database. Two groups were formed based on Hartmann's reversal within 1 year and those with nonreversal. An independent-sample t  test and logistic regression using score and nine other variables as predictors of Hartmann's nonreversal were run. Sixty-three of 93 patients (67.7%) had a Hartmann's reversal. Higher scores and higher mean age were seen in the nonreversal group (15.5 ± 3.0 vs 12.1 ±  2.5 and 73 ± 15 vs 63 ± 14 years, respectively). Patients with scores 18 or above were not reversed; 43 of 49 patients (88%) with scores of 13 or less were reversed. Logistic regression confirmed that the only predictive variable for nonreversal is a higher score. The  scoring system is predictive of nonreversibility of Hartmann's procedure for acute diverticulitis. This will be useful in allowing surgeons to strategize accurately and to counsel patients realistically. Higher scores may allow both the surgeon and patient to have a low threshold for exploring  alternatives to Hartmann's procedure.
authors.affiliation: Department of Surgery, York Hospital, York, Pennsylvania, USA. svaid@wellspan.org
authors.forename: Sachin
authors.initials: S
authors.lastname: Vaid
authors.forename: Joshua
authors.initials: J
authors.lastname: Wallet
authors.forename: Jeff
authors.initials: J
authors.lastname: Litt
authors.forename: Ted
authors.initials: T
authors.lastname: Bell
authors.forename: Rod
authors.initials: R
authors.lastname: Grim
authors.forename: Vanita
authors.initials: V
authors.lastname: Ahuja
mesh_terms: D000208:Acute Disease; D000368:Aged; D003125:Colostomy / Q000706:statistics & numerical data*; D004239:Diverticulitis, Colonic / Q000601:surgery*; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment