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Nonreversal of Hartmann's procedure for diverticulitis: derivation of a scoring system to predict nonreversal.
Dis Colon Rectum 2009; 52(8):1400-8DC

Abstract

PURPOSE

A Hartmann's procedure is performed in perforated diverticulitis, but in some patients the colostomy is never closed. Identification of patients at risk for Hartmann's nonreversal would be helpful to determine the extent of resection. The aim of this study was to quantify the risk of nonclosure by deriving a predictive score.

METHODS

Patients undergoing a Hartmann's procedure for diverticulitis were identified from database. They were separated into those who underwent Hartmann's reversal within one year of the initial operation, and those who did not. The data were analyzed in univariable and multivariable logistic regression. A predictive scoring system of Hartmann's reversal was created. The predictive power of the multivariable models, the predictive scoring system, and colorectal POSSUM physiology scores were compared.

RESULTS

Eighty of 117 patients (68.4%) had their colostomy reversed. Multivariate analysis identified age, American Society of Anesthesiologists' score, pulmonary comorbidity, preoperative blood transfusion, perforation, and anticoagulants as the factors of failure for stoma reversal. All 36 patients with a predictive score of less than 14 had their stoma reversed. Twenty-two of 25 patients (88%) with scores greater than 18 did not have a reversal. Predictive power was similar when using only colorectal POSSUM physiology scores alone, or with preoperative data.

CONCLUSIONS

More than 30% of patients undergoing a Hartmann's procedure for diverticulitis will not have their stoma reversed within a year. If this scoring system can be validated in an independent group of patients, it will be useful in allowing surgeons to strategize accurately and to counsel patients realistically.

Authors+Show Affiliations

Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19617751

Citation

Riansuwan, Woramin, et al. "Nonreversal of Hartmann's Procedure for Diverticulitis: Derivation of a Scoring System to Predict Nonreversal." Diseases of the Colon and Rectum, vol. 52, no. 8, 2009, pp. 1400-8.
Riansuwan W, Hull TL, Millan MM, et al. Nonreversal of Hartmann's procedure for diverticulitis: derivation of a scoring system to predict nonreversal. Dis Colon Rectum. 2009;52(8):1400-8.
Riansuwan, W., Hull, T. L., Millan, M. M., & Hammel, J. P. (2009). Nonreversal of Hartmann's procedure for diverticulitis: derivation of a scoring system to predict nonreversal. Diseases of the Colon and Rectum, 52(8), pp. 1400-8. doi:10.1007/DCR.0b013e3181a79575.
Riansuwan W, et al. Nonreversal of Hartmann's Procedure for Diverticulitis: Derivation of a Scoring System to Predict Nonreversal. Dis Colon Rectum. 2009;52(8):1400-8. PubMed PMID: 19617751.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nonreversal of Hartmann's procedure for diverticulitis: derivation of a scoring system to predict nonreversal. AU - Riansuwan,Woramin, AU - Hull,Tracy L, AU - Millan,Monica M, AU - Hammel,Jeffrey P, PY - 2009/7/21/entrez PY - 2009/7/21/pubmed PY - 2009/8/7/medline SP - 1400 EP - 8 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 52 IS - 8 N2 - PURPOSE: A Hartmann's procedure is performed in perforated diverticulitis, but in some patients the colostomy is never closed. Identification of patients at risk for Hartmann's nonreversal would be helpful to determine the extent of resection. The aim of this study was to quantify the risk of nonclosure by deriving a predictive score. METHODS: Patients undergoing a Hartmann's procedure for diverticulitis were identified from database. They were separated into those who underwent Hartmann's reversal within one year of the initial operation, and those who did not. The data were analyzed in univariable and multivariable logistic regression. A predictive scoring system of Hartmann's reversal was created. The predictive power of the multivariable models, the predictive scoring system, and colorectal POSSUM physiology scores were compared. RESULTS: Eighty of 117 patients (68.4%) had their colostomy reversed. Multivariate analysis identified age, American Society of Anesthesiologists' score, pulmonary comorbidity, preoperative blood transfusion, perforation, and anticoagulants as the factors of failure for stoma reversal. All 36 patients with a predictive score of less than 14 had their stoma reversed. Twenty-two of 25 patients (88%) with scores greater than 18 did not have a reversal. Predictive power was similar when using only colorectal POSSUM physiology scores alone, or with preoperative data. CONCLUSIONS: More than 30% of patients undergoing a Hartmann's procedure for diverticulitis will not have their stoma reversed within a year. If this scoring system can be validated in an independent group of patients, it will be useful in allowing surgeons to strategize accurately and to counsel patients realistically. SN - 1530-0358 UR - https://www.unboundmedicine.com/medline/citation/19617751/Nonreversal_of_Hartmann's_procedure_for_diverticulitis:_derivation_of_a_scoring_system_to_predict_nonreversal_ L2 - http://dx.doi.org/10.1007/DCR.0b013e3181a79575 DB - PRIME DP - Unbound Medicine ER -