A nutritional screening threshold for optimal outcomes after Hartmann’s reversal

Suzanne M. Arnott, Benjamin Zollinger, Sarah Haviland, Matthew Ng, Vincent Obias

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Determining is nutritionally replete enough for Hartmann’s reversal (HR) can be controversial and multifactorial. While there are many preoperative nutritional screening tools, the impact of malnourishment on HR has not been evaluated. The study aims to clarify how often patients undergoing HR are high risk for malnourishment at the time of surgery and how this impacts postoperative outcomes. Methods: From 2012–2019, all elective HRs were identified in ACS-NSQIP. Patients were categorized in a malnourished group if they met one of the following criteria: (1) BMI < 18.5 kg/m2, (2) albumin < 3.5 g/dL, or (3) > 10% body weight loss in the last 6 months. Bivariate associations of preoperative demographics and postoperative outcomes were analyzed. Multivariable logistic regression was performed to identify independent predictors for 30-day mortality and organ space wound infection. Results: 8878 procedures were evaluated (well-nourished = 7116 and malnourished = 1762). The malnourished group had higher mortality (p < 0.001), shorter operating time (p <.001), longer length of stay (p = 0.016), and higher rates of infection (p = 0.011), reintubation (p = 0.002), bleeding (p < 0.001), sepsis (p = 0.001), and reoperation (p = 0.018). In multivariate regression models, malnourishment was an independent predictor for mortality (OR = 2.72, p < 0.001) and wound infection (OR = 1.19, p = 0.028). Conclusion: A large percentage of patients undergoing HR were classified as being high-risk for malnutrition. Malnourishment was associated with some worse postoperative compilations including death and wound infection. Surgeons should routinely use preoperative screening for malnutrition to identify and attempt to optimize nutritional status prior to undergoing Hartmann’s Reversal.

Original languageEnglish (US)
Pages (from-to)2041-2048
Number of pages8
JournalInternational Journal of Colorectal Disease
Volume37
Issue number9
DOIs
StatePublished - Sep 2022
Externally publishedYes

Keywords

  • Colorectal surgery
  • Elective surgery
  • Hartmanns reversal
  • Malnutrition
  • Preoperative nutritional screening

ASJC Scopus subject areas

  • Gastroenterology

Fingerprint

Dive into the research topics of 'A nutritional screening threshold for optimal outcomes after Hartmann’s reversal'. Together they form a unique fingerprint.

Cite this