title: Who gets Hartmann's reversed in a regional centre?
abstract: BACKGROUND
  Many patients who undergo a Hartmann's procedure do not have their stoma reversed. We analysed parameters and co-morbidity scales to assess their accuracy in predicting likelihood of undergoing reversal.
  
  
  METHODS
  Retrospective analysis of 165 patients from a prospective colorectal database who were discharged home following a Hartmann's procedure at Barwon Health (Geelong, Australia), a regional centre, between 2002 and 2010. Parameters measured included age, sex, time to reversal, ICU admission and pathology results were recorded. Patients' ASA, POSSUM and Elixhauser co-morbidity scales were retrospectively analysed.
  
  
  RESULTS
  Reversal of Hartmann's was performed in 74/165 (45%) patients after a median of 294 days (range 70-902). Age (mean 58.5 vs 72.9 years, p < 0.001), ICU stay (34/74 vs 66/91, p < 0.001), ASA (p < 0.002), Elixhauser co-morbidity count (mean 1.14 vs 1.92, p < 0.002) and a malignant diagnosis (9/74 vs 31/91, p < 0.002) were all associated with a decreased reversal rate on univariate analysis. Age was the only parameter found to be significant on multivariate analysis. The complication rate was 23/74, with 7/74 noted to have major complications (Clavian-Dindo III-IV). Reasons for not reversing patients included age and co-morbidities, patient refusal, and malignant disease progression.
  
  
  CONCLUSIONS
  More than half the patients undergoing a Hartmann's procedure did not proceed to a closure of their stoma. Age was the only parameter significant in predicting those patients undergoing reversal.
authors: Department of Surgery, Barwon Health, Geelong, Australia; Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Australia. Electronic address: russell.hodgson@gmail.com.
authors: R
authors: R
authors: Hodgson
authors: Department of Surgery, Barwon Health, Geelong, Australia.
authors: V
authors: V
authors: An
authors: Department of Surgery, Barwon Health, Geelong, Australia.
authors: D A
authors: DA
authors: Stupart
authors: Department of Surgery, Barwon Health, Geelong, Australia.
authors: G D
authors: GD
authors: Guest
authors: Department of Surgery, Barwon Health, Geelong, Australia.
authors: D A K
authors: DA
authors: Watters
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects* / Q000379:methods*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Age; Co-morbidities; Colorectal; Hartmann's procedure; Regional centre; Stoma reversal; Surgery