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Primary anastomosis with diverting loop ileostomy versus Hartmann’s procedure for acute complicated diverticulitis: analysis of the National Inpatient Sample 2015–2019

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Abstract

Background

Up to 50% of patients with acute complicated diverticulitis require operative management on their index admission. There is ongoing debate as to whether primary anastomosis with diverting ileostomy versus a Hartmann’s procedure is the optimal surgical approach for these patients. This study aims to compare postoperative complications in patients undergoing either Hartmann’s procedure or primary anastomosis and diverting ileostomy for perforated diverticulitis using recent National Inpatient Sample data.

Methods

Patients who underwent either primary anastomosis with diverting ileostomy or Hartmann’s procedure for acute complicated diverticulitis from the 2015 to 2019 NIS database sample were included. Primary outcomes were postoperative in-hospital mortality and morbidity. Secondary outcomes were postoperative cause-specific complications, total admission cost, and length of stay (LOS). Univariate and multivariate regression were utilized to compare the two operative approaches.

Results

Overall, 642 patients underwent primary anastomosis with diverting ileostomy and 4,482 patients underwent Hartmann’s procedure. There was no difference in in-hospital mortality (OR 0.93, 95%CI 0.45–1.92, p = 0.84) or in-hospital morbidity (OR 1.10, 95%CI 0.90–1.35, p = 0.33). Adjusted analysis suggested shorter postoperative LOS for patients undergoing Hartmann’s procedure (MD 0.79 days, 95%CI 0.15–1.43 days, p = 0.013) and decreased total admission cost (MD $4,893.99, 95%CI $1,425.04-$8,362.94, p = 0.006).

Conclusions

The present study supports that primary anastomosis with diverting ileostomy is safe for properly selected patients presenting with complicated diverticulitis. Primary anastomosis with diverting ileostomy is associated with greater total hospitalization costs and LOS.

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Data availability

The data used in the current study is available upon request.

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Author notes

  1. Yung Lee and Tyler McKechnie are joint first authors.

Authors and Affiliations

  1. Division of General Surgery, McMaster University, Hamilton, ON, Canada

    Yung Lee, Tyler McKechnie, Yasith Samarasinghe, Cagla Eskicioglu & Dennis Hong

  2. Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA

    Yung Lee & Angela H. Kuhnen

  3. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

    Tyler McKechnie

  4. Department of Colon and Rectal Surgery, Lahey Hospital, Burlington, MA, USA

    Angela H. Kuhnen

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Yung Lee and Tyler McKechnie. The first draft of the manuscript was written by Yung Lee, and Tyler McKechnie. Yasith Samarasinghe prepared Tables 1, 2, 3 and 4 and Appendix 1, and all authors edited and commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Dennis Hong.

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Lee, Y., McKechnie, T., Samarasinghe, Y. et al. Primary anastomosis with diverting loop ileostomy versus Hartmann’s procedure for acute complicated diverticulitis: analysis of the National Inpatient Sample 2015–2019. Int J Colorectal Dis 38, 156 (2023). https://doi.org/10.1007/s00384-023-04452-3

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