Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.
Dis Colon Rectum. 2013 Jan;56(1):83-90. doi: 10.1097/DCR.0b013e318270a1a3.
Comprehensive analyses are lacking to identify predictors of postoperative complications in patients who undergo a Hartmann reversal.
The aim of this study is to identify predictive factors for morbidity after reversal.
This study is a retrospective review of prospectively collected data.
The study was conducted at Cleveland Clinic Florida.
Consecutive patients from January 2004 to July 2011 who underwent reversal were included.
Variables pertaining to Hartmann procedure and reversal were obtained for analyses in patients with and without postoperative complications. Univariate and multivariate analyses were performed.
A total of 95 patients (mean age 61 years, 56% male) underwent reversal, with an overall morbidity of 46%. Patients with and without complications had similar demographics, comorbidities, diagnoses, and Hartmann procedure intraoperative findings. Patients with complications after reversal were more likely to have prophylactic ureteral stents (61% vs 41%, p < 0.05) and an open approach (91% vs 75%, p < 0.04). Complications were associated with longer hospital stay (8.8 vs 6.9 days,p < 0.006) and higher rates of reintervention (9% vs 0%, p < 0.03) and readmission (16% vs 2%, p < 0.02). Predictors of morbidity after reversal included BMI (29 vs 26 kg/m, p < 0.04), hospital stay for Hartmann procedure (15 vs 10 days, p < 0.03), and short distal stump (50% vs 31%, p < 0.05). BMI was the only independent predictor of morbidity (p < 0.04). Obesity was associated with significantly greater overall morbidity (64% vs 40%, p < 0.04), wound infections (56% vs 31%, p < 0.04), diverting ileostomy at reversal (24% vs 13%, p < 0.05), and time between procedures (399 vs 269 days, p < 0.02).
This study was limited by its retrospective design.
Hartmann reversal is associated with significant morbidity; BMI independently predicts complications. Therefore, patients who are obese should be encouraged or even potentially required to lose weight before reversal.
缺乏综合分析来确定接受 Hartmann 反转术患者术后并发症的预测因素。
本研究旨在确定反转术后发病率的预测因素。
这是一项前瞻性收集数据的回顾性研究。
克利夫兰诊所佛罗里达分院。
纳入 2004 年 1 月至 2011 年 7 月期间接受反转术的连续患者。
对有无术后并发症的患者进行与 Hartmann 手术和反转术相关的变量分析。进行单变量和多变量分析。
共有 95 例患者（平均年龄 61 岁，56%为男性）接受了反转术，总体发病率为 46%。有并发症和无并发症的患者在人口统计学、合并症、诊断和 Hartmann 手术术中发现方面相似。接受反转术后有并发症的患者更有可能接受预防性输尿管支架（61%比 41%，p<0.05）和开放入路（91%比 75%，p<0.04）。并发症与住院时间延长（8.8 天比 6.9 天，p<0.006）、再干预率（9%比 0%，p<0.03）和再入院率（16%比 2%，p<0.02）较高相关。反转术后发病率的预测因素包括 BMI（29 比 26kg/m，p<0.04）、Hartmann 手术的住院时间（15 天比 10 天，p<0.03）和短的远端残端（50%比 31%，p<0.05）。BMI 是发病率的唯一独立预测因素（p<0.04）。肥胖与总体发病率显著增加（64%比 40%，p<0.04）、伤口感染（56%比 31%，p<0.04）、反转时的转流性回肠造口术（24%比 13%，p<0.05）和手术之间的时间（399 天比 269 天，p<0.02）有关。
本研究受限于其回顾性设计。
Hartmann 反转术与显著的发病率相关；BMI 独立预测并发症。因此，应鼓励肥胖患者甚至可能需要在反转术前减重。
