SAGES 2026 Annual Meeting Emerging Technology Session

Racial Disparities in Access to Minimally Invasive versus Open Hartmann's Reversal: A NSQIP Analysis

Backround

Racial and ethnic disparities in access to minimally invasive surgery (MIS) remain a persistent challenge in the US
Given the technical complexity of Hartmann’s reversal, this procedure provides a meaningful context in which to examine potential differences in surgical access

Aim: To determine whether racial disparities exist in access to MIS versus open surgery for elective Hartmann’s reversals.

Methods

N= 21,109 patients

Patients undergoing elective Hartmann’s reversal were identified using Current Procedural Terminology (CPT) codes

44626 (closure of enterostomy with resection and colorectal anastomosis)

44227 (laparoscopic closure of enterostomy with resection and anastomosis).

Result

Mean Age (years):

Males (%):

Mean BMI (kg/m²):

*AA: African American/Black

On univariate analysis:

African Americans have the highest rates of hypertension, smoking, diabetes, and dialysis (P<0.0001)
Asians have the highest rates of diabetes but the lowest rates of hypertension, smoking, dialysis, and COPD (P<0.0001)

Table 2. Multivariable Logistic Regression of Variables Associated with Undergoing Minimally Invasive Hartmann’s Reversal with Backwards Elimination

On multivariable logistic regression analysis (accounting for demographic, comorbidities, and all other potential risk factors):

African Americans were significantly less likely to undergo a minimally invasive procedure compared to White patients (OR 0.864, 95% CI 0.787–0.949, P = 0.002)
Asian patients were significantly more likely to undergo a minimally invasive approach compared to White patients (OR 1.454, 95% CI 1.205–1.754, P < 0.001).
Hispanic ethnicity was not independently associated with surgical approach.

Conclusion

Race is an independent risk factor influencing access to minimally invasive approaches for Hartmann’s reversal.

Racial Disparities in Access to Minimally Invasive versus Open Hartmann's Reversal: A NSQIP Analysis