Mortality following Hartmann's procedure--correlation of Dr. Foster's report with CR-POSSUM

Dr. Foster Intelligence highlighted a higher than expected mortality rate from emergency Hartmann's procedure at a district general hospital from April 2007 to March 2009 (6.5% expected, 30% actual mortality). A retrospective audit of all Hartmann's procedures over 4 years was performed.

Notes were examined for all emergency Hartmann's procedures between April 2006 and March 2010. CR-POSSUM scores were calculated for each patient. Results were analysed in SPSS (IBM Corp.).

The mean CR-POSSUM score for the entire cohort was 27.78%, which compared to an observed mortality rate of 22.5% (18/80 cases, p=0.61). There was a significant correlation between mortality and CR-POSSUM score (p=0.001) and ASA grade (p=0.001). Those aged 81 and above had a significantly higher mortality (P≤0.05). There was no statistically significant correlation between grade of surgeon and mortality (p=0.42). Overall consultant presence in theatre was 72.5% (58/79 cases) and in those that died 82.4% (14/17 cases). Those patients who had an admission to diagnosis time of 10 days or more were at significantly greater risk of death (p<0.05).

Dr. Foster's data does not sufficiently take into account the pre-operative state of each patient. The CR-POSSUM predicted mortality scores for the studied patient population and the actual mortality were similar. This suggests that the studied patient population were of a higher risk group than presumed by Dr. Foster's data. This study has highlighted that an older population and a delay in diagnosis following admission may have contributed to the increase in mortality in some cases.