Short-term outcomes following emergency Hartmann procedure: a comparison between colorectal and noncolorectal...

Given the increasing staffing shortages that often necessitate noncolorectal surgeons performing emergency colorectal procedures, this study aims to evaluate the effect of surgeon subspecialty on short-term postoperative outcomes in patients undergoing emergency Hartmann procedure and whether strengthening residency training in Hartmann procedure could improve surgical outcomes.

This retrospective study included 141 patients who underwent emergency Hartmann procedure at a single tertiary center between January 2010 and December 2021. Patients were categorized into colorectal and noncolorectal groups. The clinical characteristics, operative details, and outcomes were compared. Complications were classified using the Clavien-Dindo classification. Logistic regression analysis was used to identify complications and mortality.

The noncolorectal group showed higher age (75 years vs. 69 years, P=0.038), hypertension prevalence (58.4% vs. 40.4%, P=0.039), and physiological instability (C-reactive protein >6.0 mg/dL: 55.1% vs. 36.5%, P=0.034; lactate: 1.90 mmol/L vs. 0.80 mmol/L, P<0.001). Complications were lower in the colorectal group (68.5% vs. 36.5%, P<0.001), with fewer major complications (Clavien-Dindo grade ≥III, 51.7% vs. 15.4%). The colorectal group had a lower mortality rate (25.8% vs. 3.8%, P=0.001). In the multivariate analysis, surgery performed by noncolorectal surgeons remained a significant independent risk factor for complications (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.27-6.89; P=0.012) and mortality (OR, 15.53; 95% CI, 2.11-114.18; P=0.006) even after adjusting for age, diagnosis, American Society of Anesthesiologists physical status, C-reactive protein levels, and time to surgery.

Emergency Hartmann procedure for acute conditions yielded better short-term outcomes when performed by colorectal surgeons. These findings suggest that surgeon subspecialty is a critical determinant of survival, independent of patient severity or surgical timing. Improving surgical residency training in Hartmann procedure may enhance outcomes when noncolorectal surgeons must perform it due to staffing constraints.