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Prognostic factors for survival following emergency Hartmann's procedure
  1. Rhiannon L Harries,
  2. Chris P Twine,
  3. Gana Kugathasan,
  4. Holly Young,
  5. Evelyn Jones,
  6. Kelvin F Gomez
  1. Department of General Surgery, Nevill Hall Hospital, Abergavenny, UK
  1. Correspondence to Rhiannon L Harries, Department of General Surgery, Nevill Hall Hospital, Brecon Road, Abergavenny NP7 7EG, UK; rhiannon.harries{at}doctors.org.uk

Abstract

Introduction Patients presenting with peritonitis require rapid treatment initiation including laparotomy. In the older population, this often leads to Hartmann's procedure being performed. The decision to perform surgery may be a difficult, multidisciplinary decision balancing premorbid comorbidity and quality of life with knowledge of the postoperative outcome. However, the evidence for survival outcome of emergency surgery based on age is lacking. The aim of this study was therefore to assess the survival implication of age and other prognostic factors on the outcome after Hartmann's procedure.

Methods A retrospective review of prospectively collected data of all patients undergoing emergency (National Confidential Enquiry into Patient Outcome and Death category 1–3) Hartmann's procedure in one NHS Health Board over a 5-year period.

Results 129 patients underwent Hartmann's procedure between November 2004 and November 2009. The largest group, 61 patients (47.3%) had the procedure performed for perforated sigmoid diverticular disease. When examined at 5-year stratifications around the median, the most significant survival difference was seen at the age of 75 years (log rank χ2 11.246, p=0.001). Patients over 75 years had median survival significantly lower than those aged <75 years (p<0.001). However, Cox regression analysis showed that preoperative American Society of Anesthesiologists (ASA) status and haemoglobin were more significant independent predictors of mortality than this age strata (p=0.001 and 0.045 vs 0.660, respectively), adjusting for diagnosis.

Discussion ASA grade and common blood abnormalities were more predictive of mortality after Hartmann's procedure than the most significant age stratification. Furthermore, age was not independently associated with survival. It would therefore be unreasonable to refuse Hartmann's procedure based on an age alone.

  • Hartmann's procedure
  • survival
  • age
  • emergency
  • colorectal surgery
  • vascular surgery
  • breast surgery
  • adult surgery
  • surgery

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Gwent NHS Trust ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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