SRS159 - A 10-year retrospective service evaluation of emergency Hartmann’s procedures in patients with diverticular disease in a UK tertiary centre

Abstract Introduction Severe diverticular disease (DD) is commonly managed with a Hartmann’s procedure (HP), an emergency operation with significant physical/physiological impacts. With no guidelines for follow-up or reversal in this cohort, we aimed to assess the proportion of patients undergoing HP for DD who achieved bowel continuity restoration and identify associated factors. Methods and procedures A retrospective analysis of the National Emergency Laparotomy Audit (NELA) database from a tertiary centre was undertaken from January 2015–December 2024. Patients undergoing HP with histologically confirmed DD were included. The primary outcome was reversal of HP. Statistical analysis was performed (P-value of < 0.05 considered significant). Results Of 194 patients undergoing HP for DD, 30 died within 1 year and were excluded, leaving 164 for analysis. Of these, 47.5% did not undergo reversal, 30.5% had reversal, 14% are planned for reversal, and 8% await investigations. Mean age was significantly higher in the non-reversed group (P < 0.0001) along with NELA score (P < 0.0001). Male patients were more likely to undergo reversal than female patients (P = 0.0009; OR 3.7). Mean time to reversal was 630.54 days. ROC analysis showed good discrimination of NELA scores for reversal. The optimal threshold was 3.95. Surgeon grade discussing reversal in clinic was not significantly different between the groups. Conclusions Emergency HP is often lifesaving, but bowel continuity is restored in fewer than half of patients. Age, sex, and higher pre-operative NELA scores appear to influence decisions. Greater focus on managing acute DD and alternative techniques may reduce permanent stoma rates.