EP332 - Analysis Of Timing Of Hartmann Reversal And Postoperative Complications: Patient Factors, Indications, Short- And Long-Term Morbidity and Mortality

Purpose/Background: Proctosigmoidectomy with end colostomy, better known as Hartmann procedure, is a common emergent procedure performed primarily in the setting of colonic perforation or obstruction when an anastomosis is otherwise contraindicated. This is meant to be a temporary measure allowing the patient to recover, with the eventual goal of restoring bowel continuity and lowering potential complications of the subsequent surgery. To date, there are no universal guidelines for an appropriate timeline for ostomy reversal. Subsequently, in practice, there is a wide range of timelines between index surgery and reversal based on surgeon preference. This study aims to better delineate proper timing between Hartmann procedure and subsequent reversal procedure in order to minimize common potential postoperative complications.

Methods/Interventions: A retrospective study was performed analyzing 117 patients who had undergone Hartmann procedure and subsequent reversal procedure from 2011 – 2024 at multiple hospitals performed by multiple surgeons. These patients were divided into three groups based on time in months between procedures – early ( < 6 months, 41%), intermediate (6 months – 12 months, 37%), and late (>12 months, 22%). Primary endpoints included the rate of early ( < 30 days) and late (>30 days) complications. The data was analyzed using ANOVA and unpaired t testing.

Results/Outcomes: Findings show an increase in the rate of incisional hernias in the early group (20.8%) vs late group (8.3%), and higher surgical site infection in the early/intermediate groups (10.4%, 11.3%) versus late group (0.0%); however, neither of these were statistically significant (p=0.208; p=0.101). There were no statistically significant differences in any other short- or long-term complications, including early/delayed anastomotic leak, ileus, reoperation, prolonged TPN, UTI, or AKI, between the three groups. In terms of population, there were no statistically significant differences in age, BMI, gender, indications, or comorbidities; there was a statistically significant difference (p=0.04) in immunosuppression usage between early (15%) and intermediate/late (40%, 45%), indicating that those on chemotherapy or other immunosuppressants waited >6 months before reversal surgery was offered.

Conclusion/Discussion: This study shows that there is decreased incidence in surgical site infections and incisional hernias when ostomy reversal was performed greater than 12 months after initial Hartmann procedure. Although these results are not statistically significant, a larger sample size may better delineate the benefits of 12 months reversal time compared to earlier reversal due to decrease in complication rates.