title: The impact of surgeon volume on colostomy reversal outcomes after Hartmann's procedure for diverticulitis.
abstract: Colostomy reversal after Hartmann's procedure for diverticulitis is a morbid procedure, and studies investigating factors associated with outcomes are lacking. This study identifies patient, surgeon, and hospital-level factors associated with perioperative outcomes after stoma reversal.
  
  
  
  The Statewide Planning and Research Cooperative System was queried for urgent/emergency Hartmann's procedures for diverticulitis between 2000-2012 in New York State and subsequent colostomy reversal within 1 year of the procedure. Surgeon and hospital volume were categorized into tertiles based on the annual number of colorectal resections performed each year. Bivariate and mixed-effects analyses were used to assess the association between patient, surgeon, and hospital-level factors and perioperative outcomes after colostomy reversal, including a laparoscopic approach; duration of stay; intensive care unit admission; complications; mortality; and 30-day, unscheduled readmission.
  
  
  
  Among 10,487 patients who underwent Hartmann's procedure and survived to discharge, 63% had the colostomy reversed within 1 year. After controlling for patient, surgeon, and hospital-level factors, high-volume surgeons (≥40 colorectal resections/yr) were independently associated with higher odds of a laparoscopic approach (unadjusted rates: 14% vs 7.6%; adjusted odds ratio = 1.84, 95% confidence interval = 1.12, 3.00), shorter duration of stay (median: 6 versus 7 days; adjusted incidence rate ratio = 0.87, 95% confidence interval = 0.81, 0.95), and lower odds of 90-day mortality (unadjusted rates: 0.4% vs 1.0%; adjusted odds ratio = 0.30, 95% confidence interval = 0.10, 0.88) compared with low-volume surgeons (1-15 colorectal resections/yr).
  
  
  
  High-volume surgeons are associated with better perioperative outcomes and lower health care utilization after Hartmann's reversal for diverticulitis. These findings support referral to high-volume surgeons for colostomy reversal.
authors.affiliation: Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY. Electronic address: christopher_aquina@urmc.rochester.edu.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Aquina
authors.affiliation: Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Probst
authors.affiliation: Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY.
authors.forename: Adan Z
authors.initials: AZ
authors.lastname: Becerra
authors.affiliation: Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Hensley
authors.affiliation: Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY.
authors.forename: James C
authors.initials: JC
authors.lastname: Iannuzzi
authors.affiliation: Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY.
authors.forename: Katia
authors.initials: K
authors.lastname: Noyes
authors.affiliation: Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY; Center for Colon and Rectal Surgery, Florida Hospital Medical Group, University of Central Florida College of Medicine, Orlando, FL.
authors.forename: John R T
authors.initials: JR
authors.lastname: Monson
authors.affiliation: Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY.
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: Fleming
mesh_terms: D000208:Acute Disease; D000368:Aged; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods; D003125:Colostomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D016208:Databases, Factual; D004238:Diverticulitis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D004241:Diverticulum, Colon / Q000150:complications* / Q000601:surgery; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012086:Reoperation / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D066231:Surgeons / Q000706:statistics & numerical data*; D015996:Survival Rate; D016896:Treatment Outcome