Iyare Esemuede, MD, Alan Harzman, MD, Syed Husain, MD. Ohio State University
Background: Hartmann’s reversal is increasingly being recognized as a high-morbidity procedure. The aim of this study is to identify risk factors for SSI in the era of increasing utilization of minimally invasive techniques.
Methods: An analysis of the National Surgical Quality Improvement Program database was done from 2006-2012 and patients undergoing open or laparoscopic Hartmann reversals were identified. Emergency operations were excluded. Risk factors for SSI were compared between the two groups and included gender, age, resident involvement, Body Mass Index, diabetes mellitus, tobacco use, steroid use, chemotherapy, radiation therapy, and American Society of Anesthesiologists class. The incidence of SSI was assessed and a multivariate analysis was done to assess the strongest risk factors for it in the patient cohort using SPSS statistical software.
Results: We identified 7970 patients who underwent Hartmann’s closure. Of these, 1431 (18%) were done laparoscopically. The SSI rate in the overall population was 13.6%, with 14.9% in those undergoing open surgery and 8% with laparoscopic procedures. Obese patients and smokers had the highest incidences of SSI (18% and 17.5% respectively). On univariate analysis, open surgery, age<65, resident involvement, BMI>30, tobacco use, and OR time>180 minutes were significant predictors of SSI and remained so on multivariate analysis. Odds ratios for SSI with open surgery and obesity were 1.8 and 1.6 respectively (p<0.001). Diabetes and steroid use were not significant risk factors.
Conclusion: Hartmann’s closure is a procedure with an increased risk of SSI when compared to other colorectal procedures. The current study helps to identify patients at increased risk of SSI after surgery. Furthermore, our findings indicate that laparoscopy can significantly reduce SSI, particularly in obese patients.
| SSI (%) |
Univariate p-value |
Odds Ratio |
Multivariate p-value |
|
| Gender (male) | 13.7 | 0.9 | – | – |
| Age < 65 | 14.8 | 0.02 | 1.2 | 0.014 |
| Resident Involved | 15.4 | <0.001 | 1.4 | <0.001 |
|
Laproscopy |
8 | <0.001 | 0.5 | <0.001 |
| BMI > 30 | 18 | <0.001 | 1.6 | <0.001 |
| Diabetes | 15.9 | 0.18 | – | – |
| Tobacco | 17.5 | <0.001 | 1.4 | <0.001 |
| Chemotherapy | 9.4 | 0.22 | – | – |
| Radiation | 15.9 | 0.39 | – | – |
| ASA 3-5 | 14.9 | 0.03 | 1.2 | 0.01 |
| OR time >180 mins | 16.8 | <0.001 | 1.3 | <0.001 |
| Steroids | 15.6 | 0.3 | – | – |