Analysis of Patients Who Died Following Hartmann’s Procedure
Ruth Wieland
Department of Surgery, Logan Hospital, Armstrong Rd & Loganlea Rd, Meadowbrook Queensland 4131, Australia
Arkadiusz P. Wysocki *
Department of Surgery, Logan Hospital, Armstrong Rd & Loganlea Rd, Meadowbrook Queensland 4131, Australia and Griffith University School of Medicine, Gold Coast Campus, Parklands Drive, Southport Queensland, 4222, Australia
Therese Rey-Conde
Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, 9-69 Shafston Avenue, Kangaroo Point Queensland 4169, Australia
Jennifer Allen
Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, 9-69 Shafston Avenue, Kangaroo Point Queensland 4169, Australia
John B. North
Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, 9-69 Shafston Avenue, Kangaroo Point Queensland 4169, Australia
*Author to whom correspondence should be addressed.
Abstract
Introduction: Hartmann’s procedure is typically performed for sigmoid colon obstruction or perforation. The primary aim of this study was to compare patients who died after a Hartmann’s procedure for obstruction and perforation. The secondary aim was to collate opinions of surgeon reviewers of any clinical events.
Methods: Patients who died in Queensland, Australia after a Hartmann’s procedure, between January 2009 and December 2014, were identified from the Queensland Audit of Surgical Mortality.
Results: 275 patients died; of those 56% underwent surgery for perforation, 20% for obstruction and 24% for other indications. Patients with perforation were of the same age as those with obstruction (p = 0.178) but those with perforation were more likely to be female (p = 0.059) and have a higher ASA class (p = 0.001). Patients with perforation underwent surgery one day earlier than those with obstruction (p = 0.066) but had the same postoperative length of stay as those with obstruction (p = 0.430). Surgeon reviewers identified between 1 and 7 clinical events per patient in 105 patients (38.2%).
Conclusion: Patients with perforation who died following a Hartmann’s procedure were of a higher ASA class but had a shorter time to theatre compared to patients with obstruction. Clinical events were identified in one third of patients.
Keywords: Hartmann’s procedure, mortality, colonic obstruction, colonic perforation