title: Morbidity after reversal of Hartmann operation: retrospective analysis of 56 patients.
abstract: BACKGROUND
  Despite patient selection, postoperative morbidity after reversal of Hartmann's procedure remains significant.
  
  
  OBJECTIVE
  The objective of this study was to investigate risk factors associated with morbidity after conversion of Hartmann's operation.
  
  
  METHODS
  We retrospectively analyzed data of 56 patients who underwent reversal procedures between January 2004 and May 2015 in a single center. We evaluated the following variables: demographic characteristics, medical comorbidities, etiology for Hartmann operation, preoperative lab values, intraoperative surgical details and short-term outcomes (hospital stay, medical and surgical complications, mortality).
  
  
  RESULTS
  There were 37 men (66.1%) and the mean age was 57 years. The most frequent indications for Hartmann's procedure were colorectal cancer in 25 patients (44.6%) and complicated diverticulitis in 10 patients (17.9%). The mean time to the reversal procedure was 9 months. Morbidity rate was 16.1% (9 patients) with an anastomotic leakage rate of 3.6% (2 patients) and mortality rate was 3.6% (2 patients). The most common medical complication was diarrhea (4 patients, 7.2%). Bivariate analysis demonstrated that the only factor significantly associated with postoperative complications was presence of multiple comorbidities.
  
  
  CONCLUSIONS
  Multiple medical comorbidities is the only predictive factor for postoperative complications after Hartmann's reversal and therefore patient selection for this type of surgery is critical.
authors.affiliation: Second Department of Surgery, University Emergency Hospital Bucharest, Romania.
authors.forename: E C
authors.initials: EC
authors.lastname: Zarnescu Vasiliu
authors.affiliation: Second Department of Surgery, University Emergency Hospital Bucharest, Romania ; Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: N O
authors.initials: NO
authors.lastname: Zarnescu
authors.affiliation: Second Department of Surgery, University Emergency Hospital Bucharest, Romania ; Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: R
authors.initials: R
authors.lastname: Costea
authors.affiliation: "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: L
authors.initials: L
authors.lastname: Rahau
authors.affiliation: Second Department of Surgery, University Emergency Hospital Bucharest, Romania ; Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: S
authors.initials: S
authors.lastname: Neagu
mesh_terms: D000368:Aged; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Hartmann’s reversal; anastomotic fistula; anastomotic leakage; colostomy closure; morbidity