Hartmann's reversal is associated with worse outcomes compared to elective left colectomy: A NSQIP analysis of 36,794 cases

Yosef Nasseri; Andy Liu; Eli Kasheri; Kimberly Oka; Sean Langenfeld; Abbas Smiley; Jason Cohen; Joshua Ellenhorn; Moshe Barnajian

doi:10.1016/j.amjsurg.2022.10.026

Hartmann's reversal is associated with worse outcomes compared to elective left colectomy: A NSQIP analysis of 36,794 cases

Am J Surg. 2022 Dec;224(6):1351-1355. doi: 10.1016/j.amjsurg.2022.10.026. Epub 2022 Oct 17.

Authors

Yosef Nasseri¹, Andy Liu², Eli Kasheri², Kimberly Oka², Sean Langenfeld³, Abbas Smiley⁴, Jason Cohen², Joshua Ellenhorn², Moshe Barnajian²

Affiliations

¹ The Surgery Group of Los Angeles, Los Angeles, CA, USA; Cedars Sinai Medical Center, Los Angeles, CA, USA. Electronic address: yosefnasseri@gmail.com.
² The Surgery Group of Los Angeles, Los Angeles, CA, USA; Cedars Sinai Medical Center, Los Angeles, CA, USA.
³ University of Nebraska Medical Center, Omaha, NE, USA.
⁴ Westchester Medical Center, New York Medical College, Valhalla, NY, USA.

PMID: 36272826
DOI: 10.1016/j.amjsurg.2022.10.026

Abstract

Background: Hartmann's reversal (HR) is associated with significant technical difficulty and morbidity. Using the ACS-NSQIP database, we assessed the outcomes of HR as compared to elective left colectomy (LC).

Methods: The 2016-2019 ACS-NSQIP datasets were queried to identify patients undergoing HR and elective LC. Patients' demographics, comorbidities, and short-term surgical outcomes were evaluated using both univariable and multivariable methods.

Results: The study included 7,632 HR cases and 29,162 LC cases. The HR group had more patients with ASA grade III (50% vs. 42.4%). HR had more open-operative cases (69.4 vs. 18.5%) and longer mean operative times (213 vs. 191 min) than LC. Postoperatively, the HR group had a longer mean hospital stay (5.5 vs. 4.1 days) and higher complication rate (18.3% vs. 10.3%). HR was associated with increased odds of having a concurrent ileostomy (OR 2.11), deep space/organ infection (OR 1.55), and at least one complication (OR 1.56).

Conclusion: HR is a more challenging operation with patients who fared worse than their LC counterparts. Consideration should be given to alternatives of the index Hartmann's procedure.

Keywords: Colorectal; Elective left colectomy; Hartmann's reversal; Surgical complexity; Surgical outcomes.

MeSH terms

Anastomosis, Surgical / methods
Colectomy / methods
Colostomy / methods
Humans
Laparoscopy* / methods
Postoperative Complications / etiology
Reoperation / methods
Retrospective Studies
Treatment Outcome