eP114 - The Effect of Surgical Management of Diverticulitis: Hartmann’s vs. Loop Ileostomy/Colostomy

ePoster Presenter(s)

• RS

  Reena Suresh, MBChB

  Research fellow
  Johns Hopkins School of Medicine
  Johns Hopkins School of Medicine
  Baltimore, MD, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• 

  Ama J. Winland, MD

  General Surgery Resident, Research Fellow
  Walter Reed National Military Medical Center, Johns Hopkins Hospital
  Walter Reed National Military Medical Center
  Chevy Chase, MD, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• MS

  Miloslawa Stem, MS

  Sr. Biostatistician
  Johns Hopkins Medicine
  Baltimore, Maryland, United States

  Disclosure information not submitted.
• 

  Alodia Gabre-Kidan, MD, MPH

  Assistant Professor of Surgery
  Johns Hopkins School of Medicine
  Johns Hopkins School of Medicine
  Towson, MD, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• AB

  Andrea Bafford, MD

  Associate Professor of Clinical Surgery PAR
  Johns Hopkins Medicine
  columbia, Maryland, United States

  Disclosure information not submitted.
• AG

  Ada Graham, MD

  Assistant Professor
  Johns Hopkins Medicine
  Baltimore, Maryland, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Vincent Obias, Chief Division of Colon and Rectal Surgery NCR (he/him/his)

  Professor of Surgery (PAR)
  Johns Hopkins Medicine
  Johns Hopkins Medicine
  bethesda, Maryland, United States

  Disclosure information not submitted.

Purpose/Background: The traditional surgical management of diverticulitis frequently includes the Hartmann’s procedure, however, it is associated with significant perioperative morbidity. There is sparse evidence investigating the role of initial diversion with loop ileostomy/colostomy in the acute surgical management of diverticulitis, although, its less invasive nature has the potential to minimize operative morbidity. This study aimed to compare outcomes between diversion and Hartmann’s procedure in patients operated on with diverticulitis.Methods/Interventions: Adult patients with a diagnosis of diverticulitis who underwent diversion (loop ileostomy/colostomy) or Hartmann’s were retrospectively analyzed using the American College of Surgeons National Surgical Quality Improvement Program Database (2006-2021). To control for potential confounders, patients who underwent diversion were propensity score matched to patients who underwent Hartmann’s procedure in a 1:1 ratio. The association between surgical management and the primary outcomes of 30-day overall and serious morbidity were assessed. Secondary outcomes included 30-day mortality, reoperation, readmission, length of stay (LOS), and operative time.Results/Outcomes: Among 26,290 patients, 25,828 (98.24%) underwent Hartmann’s and 462 (1.76%) underwent diversion alone. After propensity score matching, patients undergoing Hartmann’s procedure exhibited higher rates of 30-day overall morbidity (44.59% vs 34.63%; p=0.002) and serious morbidity (32.23% vs 22.94%, p=0.002) compared to patients who underwent diversion (Table). The rates of wound complications (11.04% vs 6.93%, p=0.029) and post-operative shock/sepsis (24.24% vs 12.99%, p < 0.001) were also higher in the Hartmann’s group. Furthermore, the Hartmann’s group had longer LOS (median of 8 vs 6 days, p < 0.001) and operative time (median of 139.5 vs 84 minutes, p < 0.001). There were no differences in 30-day mortality, readmission or re-operation rates between the two groups.Conclusion/

Discussion: Fecal diversion is a safe alternate approach for the initial surgical management of diverticulitis as it is carries lower rates of 30-day overall and serious morbidity, and shorter LOS and operative time without increasing the need for re-operation. Further prospective studies and assessment of long-term outcomes will help to define the overall role of diversion alone in the management of acute diverticulitis.30-Day Post-Operative Outcomes (Matched Cohort)