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Outcomes and Predictors of Mortality in Surgical Treatment for Clostridium difficile Colitis in a High Volume Center
Ozgen Isik, Emre Gorgun*, Emina Huang, Luca Stocchi, Feza H. Remzi
Colorectal Surgery, Cleveland Clinic, Cleveland, OH
Purpose: Surgical treatment of fulminant Clostridium difficile colitis is associated with high mortality. The aim of this study is to determine factors affecting mortality, and evaluate the outcomes for surgical treatment of Clostridium difficile colitis.
Methods: Patients who underwent total colectomy for Clostridium difficile colitis between 2002 and 2013 were included. Perioperative characteristics of the surviving and deceased patients were compared. Additionally short and long-term outcomes were evaluated.
Results: In total, 108 patients (59 male) with a median age of 68 (26-94) were included, and mortality was 38%. Univariate analysis results are shown in table. Non- surviving patients had higher preoperative creatinine [2.6 (0.6-7.5) vs. 1.7 (0.3-10) mg/dl], AST [35 (10-1833) vs. 24 (9-665) U/L], lactate [2.4 (0.6-14.4) vs. 1.6 (0.3-5.9) mmol/L] and lower albumin [1.9 (1.3-3.7) vs. 2.2 (1.3-3.9) g/dl] levels (p< 0.05). On multivariate analysis, DM and postoperative requirement for vasopressors longer than 48 hours were significant predictors of mortality (p< 0.05). Median follow-up time was 12 (0- 119) months for surviving patients, and 22 of them (32.8%) had their stomas reversed during their follow-up.
Conclusion: Diabetes mellitus and postoperative vasopressor requirement longer than 48 hours are predictors of mortality in patients after total colectomy for Clostridium difficile colitis. One third of the survivors after total abdominal colectomy for Clostridium difficile colitis had their stoma reversed.
Univariate analysis results for surviving and non-surviving patients
| Surviving (%) | Non-surviving (%) | P value | | Age (years, median) | 66 (26- 87) | 71 (30- 94) | 0.015 | | ASA score | | | < 0.001 | | II | 1.5% | - | | III | 35.8% | 9.8% | | IV | 58.2% | 68.2% | | V | 4.5% | 22% | | DM | 29.9% | 51.2% | 0.026 | | Preop need for vasopressors | 25.4% | 43.9% | 0.046 | | Preop need for mechanical ventilation | 20.9% | 56.1% | < 0.001 | | Intraoperative transfusion | 61.2% | 80.5% | 0.036 | | Postop ICU stay (days, median) | 6 (0- 39) | 9 (1- 81) | 0.03 | | Postop mechanical ventilation> 48h | 53.7% | 85.4% | < 0.001 | | Postop vasopressor need> 48h | 17.9% | 73.2% | < 0.001 |
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