Is the Hartmann's procedure for diverticulitis obsolete? National trends in colectomy for diverticulitis in the emergency setting from 1993 to 2018.

Autor: AlSulaim HA; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada.; Department of Surgery, Unaizah College of Medicine, Qassim University, Unaizah, Saudi Arabia., Garfinkle R; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada., Marinescu D; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada., Morin N; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada., Ghitulescu GA; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada., Vasilevsky CA; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada., Faria J; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada., Pang A; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada., Boutros M; Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada. marylise.boutros@mcgill.ca.; Department of Surgery, McGill University, Montreal, QC, Canada. marylise.boutros@mcgill.ca.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2023 Oct; Vol. 37 (10), pp. 7717-7728. Date of Electronic Publication: 2023 Aug 10.
DOI: 10.1007/s00464-023-10317-1
Abstrakt: Background: Historically, Hartmann's procedure (HP) has been the operation of choice for diverticulitis in the emergency setting. However, recent evidence has demonstrated the safety of primary anastomosis (PA) with or without diverting ileostomy. The purpose of this study was to evaluate the trends of, and factors associated with, HP compared to PA in emergency surgery for diverticulitis over 25 years.
Methods: Using the National Inpatient Sample database, we identified adult patients ≥ 18 years old who underwent emergency surgery for diverticulitis (HP or PA) between 1993 and 2018 using ICD-9 and ICD-10 codes. Patients with inflammatory bowel disease, gastrointestinal cancer or who underwent elective diverticulitis surgery were excluded. Trends in HP were analyzed using multivariable linear regression, and factors associated with HP were assessed with multiple logistic regression.
Results: Of 499,433 patients who underwent colectomy in the emergency setting for acute diverticulitis, 271,288 (54.3%) had a HP and 228,145 (45.7%) had a PA. Median age was 61 years (IQR: 50-73), 53% were women, and 70.5% were white. The proportion of HP slightly increased over the study period-HP comprised 52.6% of included cases in 1993-98 and 55.2% of cases in 2014-2018 (p = 0.017). Advanced age (reference = 18-44 years; 45-54 years: OR 1.16, 95% CI 1.10-1.22; 55-64 years: OR 1.26, 95% CI 1.20-1.33; 65-74 years: OR 1.33, 95% CI 1.25-1.42; ≥ 75 years: OR 1.51, 95% CI 1.41-1.62), complicated diverticulitis (OR 1.41, 95% CI 1.36-1.46), and severity of illness (reference = minor; moderate: OR 1.46, 95% CI 1.38-1.54; major/extreme: OR 3.43, 95% CI 3.25-3.63) were associated with increased odds of HP.
Conclusions: Over a 26-year period, HP has remained the most performed procedure in the emergency setting for diverticulitis. Future work should focus on knowledge translation with a possible change in practice as more randomized controlled trials provide support for PA.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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