Hartmann Procedure, PAPD — Good for Older Patients With Severe Diverticulitis

Background: Advancing age is an independent predictor of prolonged morbidity and potentially mortality in patients requiring surgery for complicated diverticulitis. The 2 primary surgical procedures are sigmoidectomy and Hartmann procedure (HP) or primary anastomosis with proximal diversion (PAPD), typically loop ileostomy. It remains unclear whether these 2 approaches are comparable specifically in elderly patients, although recent data suggest that PAPD can be applied in younger patients, yielding better outcomes with comparable morbidity. Objective: To examine the outcomes of the 2 approaches—HP and PAPD—in patients aged ≥65 years with severe diverticulitis, using the days at home alive (DAHA) metric. Design: Retrospective cohort study. Methods: Consecutive elderly patients requiring HP or PAPD, from a random Medicare inpatient sample, were selected. Patients receiving HP were matched at a 4:1 ratio for comparison with patients receiving PAPD. DAHA was calculated for both groups a more...