65 - Preissitzung
16. Mai 2019, 13:45 - 15:15, Sopra 3, 4. OG
Comparative retrospective study between two French centers concerning continuity recoveries after Hartmann's intervention
N. Christou, T. Rivaille, M. Mathonnet, Presenter: N. Christou (Limoges/FR)
Hartmann's post-intervention continuity recovery indications are difficult to pose because they are often fraught with complications or failure to recover. The post-recovery morbidity and mortality rates in the literature are heterogeneous between 0.8 and 44%. The identification of risk predictive factors would therefore be very useful to help the practitioner in his approach. Given these elements, it seemed important to us to analyze the practice of two French university hospitals in order to highlight such risk factors and to allow the surgeon to select the best therapeutic strategy.
We performed a bicentric observational retrospective study between 2010 and 2015 that studied the characteristics of patients who had undergone Hartmann surgery and were subsequently reestablished. The aim of the study was to identify factors influencing morbidity and postoperative mortality of continuity recovery.
240 patients were studied including 60.4% of men. The mean age was 69.48 years, the median time to recovery was 8 months. 79.17% of patients were operated in emergency, the indication was mainly for a diverticular complication (39.17%). Seventy patients (29.2%) underwent a recovery of continuity and around 43% had complications. Some risk factors for morbidity have been pointed out: pre-operative low albuminemia (p = 0.005); corticosteroids (p = 0.004), moderate renal insufficiency (p = 0.014) and coronary artery disease (p = 0.014) favored occurrence of anastomotic fistula, itself a risk factor for mortality (p = 0.007) as an ASA≥3 score (p = 0.028).
Our study highlights an important rate of complications including significant anatomic fistula after recovery continuity. Precarious nutritional status and cardiovascular comorbidities should clearly lead us to reconsider surgical indication of continuity restoration.