The choice of operation for diverticular disease is a contentious issue, particularly in patients with acute symptoms.
In this study, researchers from the Cleveland Clinic (USA) compared early outcomes between primary resection and anastomosis, and Hartmann's resection.
They also describe a propensity score for the selection of patients for non-restorative procedures.
The team evaluated 731 patients undergoing primary resection and anastomosis (group 1) and 123 patients undergoing primary Hartmann's resection (group 2) between 1981 and 2003.
They used multifactorial logistic regression to develop a propensity score for estimating the likelihood of performing a non-restorative procedure.
The researchers found that operative 30-day mortality was 1% for primary resection and anastomosis, and 12% for Hartmann's resection.
In addition, surgical complications were 26% vs 44%, and medical complications were 5% vs 15% group 1 and group 2, respectively.
- group 1 = 33%
- group 2 = 2%
|Diseases of the Colon and Rectum|
The team did not identify any difference in the readmission rates between the two groups.
Independent predictors in favor for Hartmann's resection were BMI ≥30 kg/m2, Mannheim peritonitis index >10, operative urgency, and Hinchey stage >II.
The area under the receiver operating characteristic curve for the choice of operative procedure was 94%.
Dr Nail Aydin's team concluded, "Hartmann's resection was associated with a higher incidence of postoperative adverse events".
However, "the choice of operation was dependent on the patient presentation and intra-abdominal contamination".
This "can be quantified in the preoperative setting by the Cleveland Clinic diverticulitis propensity score".