Restoration of digestive continuity after Hartmann's procedure: ASA score is a predictive factor for risk of postoperative complications.

BACKGROUND/AIMS: Re-establishment of colonic continuity (RDC) following Hartmann's procedure is associated with high morbidity (anastomotic leak 4-16%) and mortality (0-4%) rates. The aim of this retrospective study was to evaluate the morbidity of RDC following Hartmann's procedure, and analyse the various factors that may influence the rate of complications.

METHODOLOGY

From 1996 to 2008, 158 patients were treated by Hartmann's colectomy. Hartmann's procedure is generally indicated in cases with infection in the abdominal cavity, combined with a distended or non-prepared intestine, or both. Of the 158 patients, 111 (70.3%) underwent a re-establishment of colonic continuity. The mean patient age was 63.4 years (26-91 years) ; the female/male ratio was 1:64.

RESULTS

The mean delay between the Hartmann's procedure and the RDC was 169.7 days (21-1095 days) and the mean duration of the hospital stay was 16.7 days (8-57 days). The mortality rate was 0.9% and incidence of anastomotic stricture was 3.6%. The morbidity was 38.7%. The majority of patients presenting complications had an ASA score > II, and most of the patients without complications were classified as ASA < or = II.

CONCLUSIONS

The RDC is an intervention performed safely after a 3 to 5-month delay with acceptable morbidity and negligible mortality. The ASA score is a determining factor for the risk of complications (p < 0.05).