Abstract：
Real-world data on outcomes following Hartmann\'s reversal is necessary to help optimize the patient experience. We have explored the timing between the index operation and its reversal; what investigations were carried out prior to this, and the associated short-term outcomes.
A retrospective study of all patients who underwent Hartmann\'s reversal from 2010 to 2020 within a tertiary referral centre in Melbourne, Australia. One hundred from a total of 406 (25%) who underwent an emergency Hartmann\'s procedure had a subsequent reversal. Complete patient data was available for 83 of these patients.
The average patient age was 60 years, and the median time for reversal was 14.0 (IQR 10-23) months. Seventy-nine of 83 (95%) reversals had a preoperative endoscopic evaluation of both their rectal stump and a complete colonoscopy. Stoma stenosis (n = 2), patient refusal (n = 1) and emergency reversal (n = 1) were cited reasons for not undergoing preoperative endoscopic evaluation. A third (n = 28, 34%) had a computed tomography prior to reversal; the majority was due to their underlying cancer surveillance (n = 21, 75%). Reversal was associated with a morbidity rate of 47% (n = 39). Surgical site infections (SSIs) (n = 21, 25%) were the most common type of complications encountered, with the majority being superficial (n = 15, 71%). SSIs were associated with steroid use (5/21 versus 4/62, p = 0.03) and greater hospital length of stay (6 versus 10 days, p = 0.03).
Only a quarter of emergency Hartmann\'s procedures within our institution were reversed. A significant proportion developed postoperative complications. Surgical site infection was the most common morbidity.
A retrospective study of all patients who underwent Hartmann\'s reversal from 2010 to 2020 within a tertiary referral centre in Melbourne, Australia. One hundred from a total of 406 (25%) who underwent an emergency Hartmann\'s procedure had a subsequent reversal. Complete patient data was available for 83 of these patients.
The average patient age was 60 years, and the median time for reversal was 14.0 (IQR 10-23) months. Seventy-nine of 83 (95%) reversals had a preoperative endoscopic evaluation of both their rectal stump and a complete colonoscopy. Stoma stenosis (n = 2), patient refusal (n = 1) and emergency reversal (n = 1) were cited reasons for not undergoing preoperative endoscopic evaluation. A third (n = 28, 34%) had a computed tomography prior to reversal; the majority was due to their underlying cancer surveillance (n = 21, 75%). Reversal was associated with a morbidity rate of 47% (n = 39). Surgical site infections (SSIs) (n = 21, 25%) were the most common type of complications encountered, with the majority being superficial (n = 15, 71%). SSIs were associated with steroid use (5/21 versus 4/62, p = 0.03) and greater hospital length of stay (6 versus 10 days, p = 0.03).
Only a quarter of emergency Hartmann\'s procedures within our institution were reversed. A significant proportion developed postoperative complications. Surgical site infection was the most common morbidity.
摘要：
Hartmann逆转后的实际结果数据对于帮助优化患者体验是必要的。我们已经探索了指数操作和反转之间的时间；在此之前进行了哪些调查，以及相关的短期结果。
在墨尔本三级转诊中心，对2010年至2020年所有接受Hartmann逆转的患者进行了回顾性研究。澳大利亚。共有406名（25％）接受紧急Hartmann手术的人随后发生了逆转。完整的患者数据可用于这些患者中的83例。
患者平均年龄为60岁,逆转的中位时间为14.0（IQR10-23）个月。83例逆转患者中有79例（95％）对其直肠残端和完整的结肠镜检查进行了术前内窥镜评估。造口狭窄（n=2），患者拒绝(n=1)和急诊逆转(n=1)是未接受术前内镜评估的原因.三分之一（n=28，34％）在逆转之前进行了计算机断层扫描；大多数是由于其潜在的癌症监测（n=21，75％）。逆转与47％的发病率相关（n=39）。手术部位感染（SSIs）（n=21，25％）是最常见的并发症，大多数是肤浅的(n=15，71%)。SSIs与类固醇使用（5/21对4/62，p=0.03）和住院时间更长（6对10天，p=0.03)。
我们机构内只有四分之一的Hartmann紧急程序被撤销。很大一部分发生了术后并发症。手术部位感染是最常见的发病率。
在墨尔本三级转诊中心，对2010年至2020年所有接受Hartmann逆转的患者进行了回顾性研究。
患者平均年龄为60岁,
我们机构内只有四分之一的Hartmann紧急程序被撤销。
