LOS ANGELES – Patients over the age of 80 who present with diverticulitis requiring an emergent Hartmann’s procedure have a 30-day mortality rate of 20%, results from a study of national data demonstrated.
“Given the high morbidity and mortality described in this study, further work to elucidate whether an elective surgical therapy should be pursued in the octogenarian population is warranted,” lead study author Dr. Ian C. Bostock said in an interview in advance of the annual meeting of the American Society of Colon and Rectal Surgeons.
Dr. Ian C. Bostock
In an effort to investigate the 30-day outcomes for patients undergoing emergent Hartmann’s procedures for diverticular disease, Dr. Bostock of the department of general surgery at Dartmouth Hitchcock Medical Center, Lebanon, N.H., and his associates queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2013 to identify all patients aged 80 years or older who underwent an open and laparoscopic Hartmann’s procedure in an emergency setting for diverticular disease. They divided patients into two groups: those with 30-day postoperative mortality (expired) and those alive after 30 days (alive), and used univariate analysis to assess the risk of mortality and to identify associated risk factors.
Of the 464 patients who met inclusion criteria, 91 expired within 30 days postoperatively, for a mortality rate of 20%. No statistically significant differences were observed between the expired and alive groups in terms of age, gender distribution, body mass index, smoking status, alcohol use, prior chemotherapy/radiotherapy, comorbid conditions such as diabetes, hypertension, current hemodialysis use, and operative time. Factors identified to be associated with a higher risk for death were congestive heart failure (odds ratio, 3.0), steroid use (OR, 3.0), chronic obstructive pulmonary disease (OR, 2.1), and ASA classification of greater than 3 (OR, 2.9). Additionally, the development of postoperative cardiac arrest (OR, 22.9), MI (OR, 8.7), renal failure (OR, 6.3), respiratory failure (OR, 4.7), and septic shock (OR, 5.6) were associated with death. A laparoscopic procedure was shown to have a protective effect (0.169).
“Interestingly, the most common complication in both groups was respiratory failure,” Dr. Bostock said. “These results suggest that the elderly are more prone to respiratory complications as a whole. These results have been corroborated in prior studies in patients exposed to major abdominal operations.”
Dr. Bostock acknowledged certain limitations of the study, including the fact that ACS-NSQIP is unable to track procedure-specific complications that might occur after surgery. “It mainly helps us to determine the morbidity rate after specific types of procedures,” he said. “Additionally, the exact indication for emergent operation in the patients included in our analysis is unknown since we don’t have any access to specific patient data and/or chart review.”
The researchers reported having no financial disclosures.