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Hartmann's Procedure vs Primary Anastomosis with Diverting Loop Ileostomy for Acute Diverticulitis: Nationwide Analysis of 2,729 Emergency Surgery Patients

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Lee, Jae Moo ; Bai P Chang, Jun ; El Hechi, Majed ; Kongkaewpaisan, Napaporn ; Bonde, Alexander ; Mendoza, April E ; Saillant, Noelle N ; Fagenholz, Peter J ; Velmahos, George ; Kaafarani, Haytham Ma. / Hartmann's Procedure vs Primary Anastomosis with Diverting Loop Ileostomy for Acute Diverticulitis : Nationwide Analysis of 2,729 Emergency Surgery Patients. In: Journal of the American College of Surgeons. 2019 ; Vol. 229, No. 1. pp. 48-55.

Bibtex

@article{6cc50bea7397454288a556fb65860c84,
title = "Hartmann's Procedure vs Primary Anastomosis with Diverting Loop Ileostomy for Acute Diverticulitis: Nationwide Analysis of 2,729 Emergency Surgery Patients",
abstract = "BACKGROUND: Recent small randomized trials suggest that primary anastomosis with a diverting loop ileostomy (PADLI) is a safe alternative to Hartmann's procedure (HP) for patients with acute diverticulitis necessitating emergent operation. We sought to examine the 30-day outcomes of patients undergoing emergent HP vs PADLI.METHOD: Using the American College of Surgeons NSQIP Colectomy Procedure Targeted Database from 2012 to 2016, all patients with acute diverticulitis who underwent emergent HP or PADLI were identified. Multivariable logistic models were constructed to compare the 30-day mortality, overall morbidity, and individual postoperative complications (eg surgical site infection, bleeding, sepsis) of the 2 procedures, controlling for all preoperative variables (eg demographics, comorbidities, laboratory values, illness severity), as well as intraoperative and procedure-specific variables (eg wound classification).RESULTS: Of 130,963 patients, 2,729 patients were included. Median age was 64 years, 48.5{\%} were male; the majority of patients underwent HP and only 208 (7.6{\%}) underwent PADLI. Hartmann's procedure patients had more comorbidities (eg COPD: 9.8{\%} vs 4.8{\%}; p = 0.017), were more functionally dependent (6.3{\%} vs 2.4{\%}; p = 0.025), and were sicker (eg septic shock: 11.1{\%} vs 5.3{\%}; p = 0.015) compared with PADLI patients. The mortality rates for HP vs PADLI were 7.6{\%} and 2.9{\%}, respectively (p = 0.011). The morbidity rates were 55.4{\%} and 48.6{\%}, respectively (p = 0.056). In multivariable analyses, compared with HP, PADLI did not result in increased rates of mortality (odds ratio 0.21; 95{\%} CI 0.03 to 1.58; p = 0.129) or morbidity (odds ratio 0.96; 95{\%} CI 0.63 to 1.45; p = 0.834). The odds of most major postoperative complications were also similar for HP and PADLI overall.CONCLUSIONS: Currently, surgeons perform HP more frequently than PADLI. When controlling for patient population differences, PADLI appears to be at least a safe alternative to HP for select patient populations needing emergent surgical management of acute diverticulitis.",
author = "Lee, {Jae Moo} and {Bai P Chang}, Jun and {El Hechi}, Majed and Napaporn Kongkaewpaisan and Alexander Bonde and Mendoza, {April E} and Saillant, {Noelle N} and Fagenholz, {Peter J} and George Velmahos and Kaafarani, {Haytham Ma}",
note = "Copyright {\circledC} 2019 American College of Surgeons. Published by Elsevier Inc. All rights reserved.",
year = "2019",
month = "7",
doi = "10.1016/j.jamcollsurg.2019.03.007",
language = "English",
volume = "229",
pages = "48--55",
journal = "American College of Surgeons. Journal",
issn = "1072-7515",
publisher = "Elsevier Inc",
number = "1",

}

RIS

TY - JOUR

T1 - Hartmann's Procedure vs Primary Anastomosis with Diverting Loop Ileostomy for Acute Diverticulitis

T2 - Nationwide Analysis of 2,729 Emergency Surgery Patients

AU - Lee, Jae Moo

AU - Bai P Chang, Jun

AU - El Hechi, Majed

AU - Kongkaewpaisan, Napaporn

AU - Bonde, Alexander

AU - Mendoza, April E

AU - Saillant, Noelle N

AU - Fagenholz, Peter J

AU - Velmahos, George

AU - Kaafarani, Haytham Ma

N1 - Copyright © 2019 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

PY - 2019/7

Y1 - 2019/7

N2 - BACKGROUND: Recent small randomized trials suggest that primary anastomosis with a diverting loop ileostomy (PADLI) is a safe alternative to Hartmann's procedure (HP) for patients with acute diverticulitis necessitating emergent operation. We sought to examine the 30-day outcomes of patients undergoing emergent HP vs PADLI.METHOD: Using the American College of Surgeons NSQIP Colectomy Procedure Targeted Database from 2012 to 2016, all patients with acute diverticulitis who underwent emergent HP or PADLI were identified. Multivariable logistic models were constructed to compare the 30-day mortality, overall morbidity, and individual postoperative complications (eg surgical site infection, bleeding, sepsis) of the 2 procedures, controlling for all preoperative variables (eg demographics, comorbidities, laboratory values, illness severity), as well as intraoperative and procedure-specific variables (eg wound classification).RESULTS: Of 130,963 patients, 2,729 patients were included. Median age was 64 years, 48.5% were male; the majority of patients underwent HP and only 208 (7.6%) underwent PADLI. Hartmann's procedure patients had more comorbidities (eg COPD: 9.8% vs 4.8%; p = 0.017), were more functionally dependent (6.3% vs 2.4%; p = 0.025), and were sicker (eg septic shock: 11.1% vs 5.3%; p = 0.015) compared with PADLI patients. The mortality rates for HP vs PADLI were 7.6% and 2.9%, respectively (p = 0.011). The morbidity rates were 55.4% and 48.6%, respectively (p = 0.056). In multivariable analyses, compared with HP, PADLI did not result in increased rates of mortality (odds ratio 0.21; 95% CI 0.03 to 1.58; p = 0.129) or morbidity (odds ratio 0.96; 95% CI 0.63 to 1.45; p = 0.834). The odds of most major postoperative complications were also similar for HP and PADLI overall.CONCLUSIONS: Currently, surgeons perform HP more frequently than PADLI. When controlling for patient population differences, PADLI appears to be at least a safe alternative to HP for select patient populations needing emergent surgical management of acute diverticulitis.

AB - BACKGROUND: Recent small randomized trials suggest that primary anastomosis with a diverting loop ileostomy (PADLI) is a safe alternative to Hartmann's procedure (HP) for patients with acute diverticulitis necessitating emergent operation. We sought to examine the 30-day outcomes of patients undergoing emergent HP vs PADLI.METHOD: Using the American College of Surgeons NSQIP Colectomy Procedure Targeted Database from 2012 to 2016, all patients with acute diverticulitis who underwent emergent HP or PADLI were identified. Multivariable logistic models were constructed to compare the 30-day mortality, overall morbidity, and individual postoperative complications (eg surgical site infection, bleeding, sepsis) of the 2 procedures, controlling for all preoperative variables (eg demographics, comorbidities, laboratory values, illness severity), as well as intraoperative and procedure-specific variables (eg wound classification).RESULTS: Of 130,963 patients, 2,729 patients were included. Median age was 64 years, 48.5% were male; the majority of patients underwent HP and only 208 (7.6%) underwent PADLI. Hartmann's procedure patients had more comorbidities (eg COPD: 9.8% vs 4.8%; p = 0.017), were more functionally dependent (6.3% vs 2.4%; p = 0.025), and were sicker (eg septic shock: 11.1% vs 5.3%; p = 0.015) compared with PADLI patients. The mortality rates for HP vs PADLI were 7.6% and 2.9%, respectively (p = 0.011). The morbidity rates were 55.4% and 48.6%, respectively (p = 0.056). In multivariable analyses, compared with HP, PADLI did not result in increased rates of mortality (odds ratio 0.21; 95% CI 0.03 to 1.58; p = 0.129) or morbidity (odds ratio 0.96; 95% CI 0.63 to 1.45; p = 0.834). The odds of most major postoperative complications were also similar for HP and PADLI overall.CONCLUSIONS: Currently, surgeons perform HP more frequently than PADLI. When controlling for patient population differences, PADLI appears to be at least a safe alternative to HP for select patient populations needing emergent surgical management of acute diverticulitis.

U2 - 10.1016/j.jamcollsurg.2019.03.007

DO - 10.1016/j.jamcollsurg.2019.03.007

M3 - Journal article

VL - 229

SP - 48

EP - 55

JO - American College of Surgeons. Journal

JF - American College of Surgeons. Journal

SN - 1072-7515

IS - 1

ER -

ID: 58123615