Exploring Differences in Days Alive and at Home after Hartmann's Procedure vs Primary Anastomosis with Proximal Diversion for Older Adults with Diverticulitis.

Abstract

Diverticulitis poses a significant public health burden, particularly among older adults (65 years and older). Hartmann's procedure (HP) and primary anastomosis with proximal diversion (PAPD) are the most common surgeries performed, although comparative studies do not highlight older adults. We analyzed days alive and at home (DAAH), a patient-centered outcome, for 6 months (DAAH 6Mo ) after diverticulitis surgery, as well as non-home discharge rate. We hypothesized that PAPD recipients would have decreased DAAH 6Mo and increased non-home discharge compared with HP. A retrospective cohort study of community-dwelling Medicare beneficiaries undergoing HP vs PAPD was performed. The primary outcome DAAH 6Mo was calculated by subtracting total inpatient, emergency department, and mortality days from 180, beginning with the day of admission. HP and PAPD patients were matched using 2-stage greedy matching (4:1 ratio). Generalized estimating equations were used to calculate incidence rate ratios (IRRs) and 95% CIs. A total of 1,368 participants were included; ultimately, 553 HP were matched with 215 PAPD patients. Baseline characteristics and unweighted DAAH 6Mo (144.5 HP vs 144.4 PAPD) were similar between matched groups. In generalized estimating equation models, HP was associated with a nonsignificant increase in DAAH 6Mo compared with PAPD (IRR 1.04, 95% CI 0.99 to 1.08), and a statistically insignificant 9% increase in non-home discharge probability (odds ratio 1.09, 95% CI 0.78 to 1.53). Results were similar for the DAAH 6Mo outcome when limited to urgent or emergent admissions (IRR 1.00, 95% CI 0.94 to 1.05). Postoperative DAAH 6Mo do not significantly differ for adults aged 65 years and older after HP or PAPD for diverticulitis. Either surgical option can be considered in both emergent and nonemergent situations, allowing the decision to be tailored to surgeon expertise and patient preferences.