title: Morbidity and mortality of the Hartmann procedure for diverticular disease over 18 years in a single institution.
abstract: OBJECTIVE
  Hartmann's procedure for perforated diverticulitis is associated with substantial morbidity and mortality. This study analyses factors associated with morbidity/mortality and possible changes over time.
  
  
  METHODS
  Patients treated by urgent Hartmann's procedure for perforated diverticulitis between 1992 and 2010 were studied, and information was collected on age, sex, perioperative details, 30-day morbidity and mortality recorded in an institutional review board approved database supplemented by chart review. Patients were divided into four groups based on the year of surgery. Univariate and multivariate logistic regression analysis was performed to identify risk factors associated with morbidity and mortality.
  
  
  RESULTS
  In all, 199 patients (51% female, mean age 65 years, mean body mass index 28 kg/m(2)) were identified. The American Society of Anesthesiologists (ASA) score was 4 in 30% of patients and Hinchey Stage IV in 16%. The mean length of stay was 12.5 ± 10 days. Mortality was 15% and did not change significantly over time. Overall morbidity was 52% and significantly increased over time on univariate analysis (P = 0.007) but not on multivariate analysis (P = 0.11). Independent predictors of morbidity on multivariate analysis were Hinchey IV (P < 0.001) and hypoproteinaemia (P = 0.001). Independent predictors for mortality were ASA > 3 (P = 0.01), abnormal creatinine (P = 0.007), steroid use (P = 0.007), Hinchey IV (P = 0.032), low albumin (P < 0.001) and low body mass index (P = 0.001).
  
  
  CONCLUSIONS
  Mortality after Hartmann's procedure for perforated diverticulitis has not decreased during the last 18 years. Morbidity has actually increased over time although this is related to increased disease severity and comorbidity. Future efforts should focus on the identification of patient subgroups benefiting from earlier elective surgery and alternative surgical approaches when perforated diverticulitis does occur.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: M
authors.initials: M
authors.lastname: Ince
authors.forename: L
authors.initials: L
authors.lastname: Stocchi
authors.forename: S
authors.initials: S
authors.lastname: Khomvilai
authors.forename: D S
authors.initials: DS
authors.lastname: Kwon
authors.forename: J P
authors.initials: JP
authors.lastname: Hammel
authors.forename: R P
authors.initials: RP
authors.lastname: Kiran
mesh_terms: D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods* / Q000401:mortality; D004239:Diverticulitis, Colonic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome