title: Mortality following Hartmann's procedure--correlation of Dr. Foster's report with CR-POSSUM.
abstract: OBJECTIVE
  Dr. Foster Intelligence highlighted a higher than expected mortality rate from emergency Hartmann's procedure at a district general hospital from April 2007 to March 2009 (6.5% expected, 30% actual mortality). A retrospective audit of all Hartmann's procedures over 4 years was performed.
  
  
  METHODS
  Notes were examined for all emergency Hartmann's procedures between April 2006 and March 2010. CR-POSSUM scores were calculated for each patient. Results were analysed in SPSS (IBM Corp.).
  
  
  RESULTS
  The mean CR-POSSUM score for the entire cohort was 27.78%, which compared to an observed mortality rate of 22.5% (18/80 cases, p=0.61). There was a significant correlation between mortality and CR-POSSUM score (p=0.001) and ASA grade (p=0.001). Those aged 81 and above had a significantly higher mortality (P≤0.05). There was no statistically significant correlation between grade of surgeon and mortality (p=0.42). Overall consultant presence in theatre was 72.5% (58/79 cases) and in those that died 82.4% (14/17 cases). Those patients who had an admission to diagnosis time of 10 days or more were at significantly greater risk of death (p<0.05).
  
  
  CONCLUSIONS
  Dr. Foster's data does not sufficiently take into account the pre-operative state of each patient. The CR-POSSUM predicted mortality scores for the studied patient population and the actual mortality were similar. This suggests that the studied patient population were of a higher risk group than presumed by Dr. Foster's data. This study has highlighted that an older population and a delay in diagnosis following admission may have contributed to the increase in mortality in some cases.
authors: Department of General Surgery, Manor Hospital, Walsall, West Midlands WS2 9PS, UK. neerajlal83@gmail.com
authors: Neeraj
authors: N
authors: Lal
authors: Pritam
authors: P
authors: Singh
authors: Chaminda
authors: C
authors: Sellahewa
authors: Rajan
authors: R
authors: Patel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003125:Colostomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D006113:United Kingdom / Q000453:epidemiology