Outcomes of Hartmann's procedure and subsequent intestinal restoration. Which patients are most likely to undergo reversal?

Aim of the study was to describe characteristics and outcomes of Hartmann's procedure (HP) and subsequent intestinal restoration. Retrospective study including all patients who underwent HP over a period of 16 consecutive years. We propose a classification and regression tree for a more accurate view of the relationship between the variables related to intestinal restoration and their weighting in the decision to reverse HP. 533 patients were included. Overall morbidity rate of HP was 53.5% and mortality 21.0%. Overall morbidity of the intestinal continuity reconstruction was 47.3% and mortality 0.9%. Patients with a benign disease, aged under 69 years and with low comorbidity, had an 84.4% probability of undergoing intestinal reconstruction. HP is associated with high morbidity and mortality. Restoration of intestinal continuity involves minor, but frequent, morbidity and a low mortality rate. Age and comorbidities can decrease, and even override, the decision to reverse HP. •Hartmann's procedure is still associated with high morbidity and mortality rates.•The most frequent cause of death along the follow-up period after a Hartmann's procedure was unrelated to the process.•Restoration of intestinal continuity involves minor, but frequent, morbidity and a low mortality rate.•Over recent years a trend to perform less Hartmann's procedure and more intestinal continuity restorations can be observed.•Patients under 69 years with low comorbidity and benign disease had the highest probability of intestinal reconstruction.