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

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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.

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Acknowledgements

“The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors” [27].

Funding

There was no grant support or financial relationship involved in the conduction of this project or preparation of this manuscript. Drs. Suzanne Arnott, Sarah Haviland, Matthew Ng, Vincent Obias and Benjamin Zollinger do not have any financial or non-financial competing interests related to this project. This is a retrospective observational study. All procedures were performed as part of routine care. The GWU Institutional Review Board confirmed that no ethical approval is required.

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Authors and Affiliations

  1. Department of Colorectal Surgery, George Washington University, Washington, D.C, USA

    Suzanne M. Arnott MD, Sarah Haviland MD, Matthew Ng MD & Vincent Obias MD

  2. Department of Surgery, George Washington University, Washington, D.C, USA

    Suzanne M. Arnott MD

  3. School of Medicine and Health Sciences, George Washington University, Washington, D.C, USA

    Benjamin Zollinger BS

  4. Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Sarah Haviland MD

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Suzanne M Arnott and Sarah Haviland. The first draft of the manuscript was written by Suzanne M Arnott and Benjamin Zollinger and all authors commented on previous versions of the manuscript. Reviewing, editing and supervision was performed by Sarah Haviland, Matthew Ng and Vincent Obias. All authors read and approved the final manuscript.

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Correspondence to Suzanne M. Arnott MD.

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Arnott, S.M., Zollinger, B., Haviland, S. et al. A nutritional screening threshold for optimal outcomes after Hartmann’s reversal. Int J Colorectal Dis 37, 2041–2048 (2022). https://doi.org/10.1007/s00384-022-04236-1

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