Factors Predicting the Reversal of Hartmann’s Procedure

Abstract

Aim. This paper investigates the risk factors preventing the reversal and nonreversal of Hartmann’s procedure, as a surgical technique that has been performed in our clinic for ten years. Methods. The study involved a ten-year Hartmann’s procedure followed up at our center. The patients were divided into Hartmann reversal and nonreversal groups. Groups were examined in terms of age, gender, diagnosis, stage of malignancy, ASA score, comorbidity, perioperative morbidity-mortality, and the length of the operation. Results. Age ( p < 0.001 ), ASA score ( p < 0.001 ), stage in case of malignancy ( p = 0.002 ), and comorbidities ( p < 0.001 ) were significant risk factors. The ratio of patients without any comorbidities to those with one or more comorbidities was 2.63 (95% CI 1.12–6.20). Among the malignant patients, the ratio of early-stage patients to advanced-stage patients in the group with reversal of Hartmann’s colostomy was 2.82 (95% CI 1.30–6.10). In addition, the ratio of older patients to younger patients in group 2 was 0.95 (95% CI 0.92–0.98). A univariate analysis revealed that younger patients, those with lower ASA scores, those without comorbidities, and those with early-stage malignancy had a greater chance of closure of the stoma. Conclusion. Although Hartmann’s procedure is performed in emergency surgery, the nonreversal of the colostomy is a problem in itself. It should be kept in mind that patients who have high risks are likely to have a permanent stoma.

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

“…65.7% of patients with ASA score status ≥ 3 and 47.8% of ASA score < 3 patients were treated with HP. ASA score status > 3 has been reported as independent risk factor for postoperative complications, especially in high-risk patients with bowel perforation and diffuse peritonitis [ 38 – 40 ].…”