Mortality after emergency Hartmann's procedure in octogenarians: a propensity score-matched analysis

Area of Science:

• Colorectal Surgery
• Surgical Outcomes
• Geriatric Surgery

Background:

• Complicated diverticulitis carries a significant postoperative mortality risk.
• The impact of advanced age on mortality after Hartmann's procedure for diverticulitis is not fully elucidated.
• This study investigates age as an independent risk factor for mortality in this patient population.

Purpose of the Study:

• To determine if age ≥80 is an independent risk factor for mortality after Hartmann's procedure for diverticular disease.
• To compare mortality rates between octogenarian and younger patients undergoing the procedure, controlling for comorbidities.

Main Methods:

• Retrospective analysis of 2986 patients undergoing urgent/emergent Hartmann's procedure for diverticular disease (2005-2013).
• Propensity score matching was used to create comparable groups of patients ≥80 years old and <80 years old.
• Univariate and multivariable logistic regression analyses were performed to identify mortality risk factors.

Main Results:

• Of 2986 patients, 464 (15.5%) were ≥80 years old. Propensity matching yielded two groups of 284 patients each.
• Mortality was significantly higher in the ≥80 group (19%) compared to the <80 group (9.2%) (P=0.001).
• Factors associated with mortality included ascites, prior cardiac surgery, functional dependence, low albumin, and ASA class >3.

Conclusions:

• Octogenarians undergoing emergent Hartmann's procedure for complicated diverticulitis face a higher mortality rate.
• Advanced age (≥80) is an independent risk factor for mortality, even when baseline comorbidities are controlled.
• These findings highlight the increased vulnerability of elderly patients undergoing this surgical procedure.