Two Operative Strategies for Complicated Diverticulitis in Older Adults Yield Similar Outcomes

Exploring Differences in Days Alive and at Home after Hartmann’s Procedure vs Primary Anastomosis with Proximal Diversion for Older Adults with Diverticulitis. Cairns CA, Carlisle KM, Ryan KA, et al. J Am Coll Surg. October 16, 2025.

Hartmann’s procedure (HP) and primary anastomosis with proximal diversion (PAPD) represent two operative strategies for complicated diverticulitis in older adults, each balancing anastomotic risk against functional recovery. 

This retrospective cohort study used Medicare data to evaluate days alive and at home at 6 months (DAAH₆Mo) as a measure of postoperative recovery and independence. 

Among 1,368 patients aged 65 years and older, 553 underwent HP and 215 PAPD after propensity matching. Median DAAH₆Mo was similar between groups (144.5 versus 144.4 days). Adjusted analyses showed no significant difference in DAAH₆Mo (IRR 1.04, 95% CI 0.99–1.08) or non-home discharge rates (OR 1.09, 95% CI 0.78–1.53). Results were unchanged in urgent and emergent cases (IRR 1.00, 95% CI 0.94–1.05).

For older adults with diverticulitis, HP and PAPD yield equivalent recovery trajectories when measured by time alive and at home. This suggests that surgical decision-making should be guided by intraoperative judgment, patient frailty, and institutional resources rather than expectations of improved functional independence with one technique over the other. 

Ultimately, optimizing outcomes for this population depends less on the operation selected and more on tailored perioperative care and multidisciplinary coordination to maximize safe discharge and durable recovery.