Association between operative approach and complications in patients undergoing Hartmann's reversal

作者：Cellini C; Deeb A P; Sharma A; Monson J R T; Fleming F J^*

来源：British Journal of Surgery, 2013, 100(8): 1094-1099.

DOI：10.1002/bjs.9153

Background Complications following reversal of Hartmann's procedure are common, with morbidity rates of up to 50 per cent, and a mortality rate as high as 10 per cent. This is based on case series with heterogeneous data collection and analysis. This study determined risk factors for complications following Hartmann's reversal. Methods Patients who underwent elective open and laparoscopic Hartmann's reversal were identified from the American College of Surgeons National Surgical Quality Improvement Program database (2005-2010). The programme collects patient demographics, preoperative medical history, clinical findings and laboratory investigations. Postdischarge data were obtained by a certified reviewer. Complications were categorized as major, septic or incisional. Risk-adjusted 30-day outcomes were assessed by univariable and multivariable analyses, adjusting for patient characteristics, co-morbidity and operative approach. Results During the study period 7996 patients had a Hartmann's procedure and 2567 cases of Hartmann's reversal were identified, including 336 laparoscopic procedures (13 center dot 1 per cent). Major, septic and incisional complication rates were 13 center dot 3, 8 center dot 5 and 15 center dot 7 per cent respectively, with a mortality rate of 0 center dot 5 per cent. A laparoscopic approach was found to be independently associated with fewer major (odds ratio (OR) 0 center dot 53, 95 per cent confidence interval 0 center dot 34 to 0 center dot 81), septic (OR 0 center dot 48, 0 center dot 27 to 0 center dot 83) and incisional (OR 0 center dot 54, 0 center dot 37 to 0 center dot 80) complications. A history of chronic obstructive pulmonary disease (OR 1 center dot 78-2 center dot 00), steroid use (OR 1 center dot 75), body mass index at least 30kg/m2 (OR 1 center dot 48), diabetes (OR 1 center dot 40), smoking (OR 1 center dot 33-1 center dot 40), American Society of Anesthesiologists fitness grade III and IV (OR 1 center dot 46-1 center dot 48) and prolonged operating time (OR 1 center dot 02) were other factors associated with complications. Conclusion A laparoscopic approach to Hartmann's reversal was associated with fewer complications than open surgery in this highly selected group of patients.

• 出版日期2013-7