Risk Factors for Clostridium Difficile Colitis Requiring Colectomy
Steven J. Nurkin, M.D., Howard I. Tiszenkel, M.D., Lisa Galati – Burke, P.A.C., Kedar Oak, M.H.A., James Turne,r M.D.
Introduction: Clostridium difficile infection (CDI) is one of the most common nosocomial infections and a frequent cause of morbidity and mortality among elderly hospitalized patients. According to multiple reports, the disease seems to be more prevalent, virulent and refractory to medical therapy than it was in the past.
Methods: A prospective, multi-institutional, risk-adjusted cohort study of patients undergoing colectomy for CDI was performed from the 228 hospitals participating in the American College of Surgeons Patient Safety in Surgery Study of the National Surgical Quality Improvement Program (ACS-NSQIP). Demographic, clinical, and intraoperative variables and 30-day morbidity and mortality were prospectively collected in standardized fashion.
Results: Reviewing the 2005-2007 databases, we identified 127 patients that underwent colectomy. Eighty-eight patients (69%) were discharged from the hospital alive. Operative mortality was 30.7%. The mean age of the mortality group was 75 years and the survival group was 64 years, p-value = 0.0006. Overall mean pre-operative WBC counts for all colectomy patients was 26,600. A trend for a higher mean pre-operative WBC count was observed in the mortality group (29,000) compared to the survival group (25,000), but was not statistically significant. 43% of patients were transferred from a health care facility prior to operation (i.e. chronic care facility or an acute care hospital). The average preoperative BUN was 41mg/dl and creatinine was 2.2mg/dl.
There were 28.3% of the patients on a ventilator and 54% of the patients were in septic shock just prior to colectomy.
Conclusion: Operative intervention for CDI has a poor prognosis. Detection of risk factors, and clinical variables early on, may help with earlier surgical intervention and improved outcomes.