Abstract
Utility of a Large, Retrospective Database in Guiding Deliberate Use of Primary Anastomosis With Proximal Diversion
Highlights
The use of urgent Primary resection with anastomosis and proximal diversion (PAPD) for Hinchey stage III or IV disease has increased following the aforementioned changes in ASCRS guidelines, overall use remains low, at approximately 8% based on National Surgical Quality Improvement Program 2012 to 2016 data.[2-4]
Among patients receiving resection and diversion, Hartmann procedure (HP) was more commonly used (94.7% vs 5.3%), the rate of PAPD use increased during the study period, from 2.6% to 7.1%
These findings are consistent with the results of randomized clinical trials (RCTs), which have demonstrated similar rates of morbidity and mortality between PAPD and HP and increased rates of stoma reversal with the former procedure.[4,5]
Summary
The use of urgent PAPD for Hinchey stage III or IV disease has increased following the aforementioned changes in ASCRS guidelines, overall use remains low, at approximately 8% based on National Surgical Quality Improvement Program 2012 to 2016 data.[2-4]. Given the relative paucity of large, nationally sourced studies, Sanaiha and colleagues[7] performed a retrospective cohort study using the 2014 to 2017 Nationwide Readmissions Database (NRD) to investigate the association of HP vs PAPD with postoperative outcomes.
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