What are the outcomes of emergency colectomy in Clostridium difficile (C diff) colitis?

Updated: Jul 25, 2019
  • Author: Faten N Aberra, MD, MSCE; Chief Editor: BS Anand, MD  more...
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Lee and colleagues evaluated clinical factors associated with mortality in emergency colectomies performed for C difficile colitis. They used the ACS-NSQIP database from 2005 to 2010 to study emergently performed open colectomies for a primary diagnosis of C difficile colitis on the International Classification of Diseases, Ninth Revision. They compared the preoperative, intraoperative, and postoperative factors between survivors and nonsurvivors. To study clinical factors that may be associated with 30-day mortality, they performed multivariate stepwise binomial logistic regression analyses. The overall mortality for this cohort was 33% (111/335) with a median time to death of 8 days. Survivors were discharged, on average, on postoperative day 24. [55]

On multivariate analysis, those aged 80 years or older were associated with a ninefold increase in the odds of mortality. Other factors associated with increased mortality were preoperative shock, preoperative dialysis dependence, chronic obstructive pulmonary disease, and wound class III. In addition, thrombocytopenia, coagulopathy, and renal insufficiency were associated with a higher mortality. This is the largest series of colectomies performed for C difficile colitis in the literature. The investigators’ findings may be useful in selecting appropriate patients for surgical intervention and may help to define a population where surgery may not be beneficial. [55]

For more information, see the Medscape Drugs & Diseases articles Toxic Megacolon and Pseudomembranous Colitis Surgery.

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