We have located links that may give you full text access.
COMPARATIVE STUDY
JOURNAL ARTICLE
Nonreversal of Hartmann's procedure for diverticulitis: derivation of a scoring system to predict nonreversal.
Diseases of the Colon and Rectum 2009 August
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.
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.
Full text links
Trending Papers
A Personalized Approach to the Management of Congestion in Acute Heart Failure.Heart International 2023
Potential Mechanisms of the Protective Effects of the Cardiometabolic Drugs Type-2 Sodium-Glucose Transporter Inhibitors and Glucagon-like Peptide-1 Receptor Agonists in Heart Failure.International Journal of Molecular Sciences 2024 Februrary 21
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app