Tsuchiya A, et al. - In this study, a comparison was performed of postoperative mortality and morbidity between Hartmann’s procedure (HP) and primary anastomosis (PA) without a diverting stoma for colorectal perforation of various etiologies. Findings suggested a significant difference in 30-day mortality between HP and PA without a diverting stoma.

Methods

• Using the Japanese Diagnosis Procedure Combination database, data on patients who underwent emergency open laparotomy for colorectal perforation of various etiologies was extracted from July 1, 2010 to March 31, 2014.
• Comparison was performed of 30-day mortality, postoperative complication rates, and postoperative critical care interventions between HP and PA groups using propensity score matching, inverse probability of treatment weighting, and instrumental variable analyses to adjust for measured and unmeasured confounding factors.

Results

• 8500 eligible patients were identified (5455 HP and 3045 PA).
• The propensity score-matched model suggested a significant difference between the HP and PA groups regarding 30-day mortality (7.7% vs. 9.6%; risk difference, 1.9%; 95% confidence interval [CI], 0.5–3.4).
• The inverse probability of treatment weighting indicated similar findings (8.8% vs. 10.7%; risk difference, 1.9%; 95% CI, 1.0–2.8).
• The point estimate, in the instrumental variable analysis, indicated similar direction to that of the propensity score analyses (risk difference, 4.4%; 95% CI, -3.3 to 12.1).
• Significantly higher rates of secondary surgery for complications were observed in PA group (4.6% vs. 8.4%; risk difference, 3.8%; 95% CI, 2.5–4.1); the group, in addition, had slightly longer duration of postoperative critical care interventions.