The impact of surgeon volume on colostomy reversal outcomes after Hartmann's procedure for diverticulitis

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• 作者：Christopher T. Aquina ; MD ; MPH^a ; ^{christopher_aquina@urmc.rochester.edu" class="auth_mail" title="E-mail the corresponding author} ; Christian P. Probst ; MD ; MPH^a ; Adan Z. Becerra ; BA^a ; Bradley J. Hensley ; MD ; MBA^a ; James C. Iannuzzi ; MD ; MPH^a ; Katia Noyes ; PhD ; MPH^a ; John R.T. Monson ; MD ; FACS^a ; ^b ; Fergal J. Fleming ; MD^a
• 刊名：Surgery
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：160
• 期：5
• 页码：1309-1317
• 全文大小：336 K

文摘

Colostomy reversal after Hartmann's procedure for diverticulitis is a morbid procedure, and studies investigating factors associated with outcomes are lacking. This study identifies patient, surgeon, and hospital-level factors associated with perioperative outcomes after stoma reversal.

Methods

The Statewide Planning and Research Cooperative System was queried for urgent/emergency Hartmann's procedures for diverticulitis between 2000–2012 in New York State and subsequent colostomy reversal within 1 year of the procedure. Surgeon and hospital volume were categorized into tertiles based on the annual number of colorectal resections performed each year. Bivariate and mixed-effects analyses were used to assess the association between patient, surgeon, and hospital-level factors and perioperative outcomes after colostomy reversal, including a laparoscopic approach; duration of stay; intensive care unit admission; complications; mortality; and 30-day, unscheduled readmission.

Results

Among 10,487 patients who underwent Hartmann's procedure and survived to discharge, 63% had the colostomy reversed within 1 year. After controlling for patient, surgeon, and hospital-level factors, high-volume surgeons (≥40 colorectal resections/yr) were independently associated with higher odds of a laparoscopic approach (unadjusted rates: 14% vs 7.6%; adjusted odds ratio = 1.84, 95% confidence interval = 1.12, 3.00), shorter duration of stay (median: 6 versus 7 days; adjusted incidence rate ratio = 0.87, 95% confidence interval = 0.81, 0.95), and lower odds of 90-day mortality (unadjusted rates: 0.4% vs 1.0%; adjusted odds ratio = 0.30, 95% confidence interval = 0.10, 0.88) compared with low-volume surgeons (1–15 colorectal resections/yr).

Conclusion

High-volume surgeons are associated with better perioperative outcomes and lower health care utilization after Hartmann's reversal for diverticulitis. These findings support referral to high-volume surgeons for colostomy reversal.