Early colectomy may be associated with improved survival in fulminant Clostridium difficile colitis: an 8-year experience

Seder, Christopher W.; Villalba, Mario R.; Robbins, James; Ivascu, Felicia A.; Carpenter, Christopher F.; Dietrich, Mary; Villalba, Mario R.

doi:10.1016/j.amjsurg.2008.11.001

« Previous Next »The American Journal of Surgery
Volume 197, Issue 3 , Pages 302-307, March 2009

Early colectomy may be associated with improved survival in fulminant Clostridium difficile colitis: an 8-year experience

Christopher W. Seder, M.D.
- Department of Surgery, Division of Infectious Diseases, William Beaumont Hospitals, Royal Oak, MI 48073, USA
Mario R. Villalba Jr., M.D.
- Department of Surgery, Division of Infectious Diseases, William Beaumont Hospitals, Royal Oak, MI 48073, USA
James Robbins, M.D.
- Department of Surgery, Division of Infectious Diseases, William Beaumont Hospitals, Royal Oak, MI 48073, USA
Felicia A. Ivascu, M.D.
- Department of Surgery, Division of Infectious Diseases, William Beaumont Hospitals, Royal Oak, MI 48073, USA
Christopher F. Carpenter, M.D.
- Department of Internal Medicine, Division of Infectious Diseases, William Beaumont Hospitals, Royal Oak, MI 48073, USA
Mary Dietrich, B.S.N.
- Department of Epidemiology, William Beaumont Hospitals, Royal Oak, MI 48073, USA
Mario R. Villalba Sr., M.D.
- Department of Surgery, Division of Infectious Diseases, William Beaumont Hospitals, Royal Oak, MI 48073, USA
- Corresponding author. Tel.: +01-248-288-1130; fax: +01-248-288-5931

Received 22 August 2008; received in revised form 8 November 2008

Abstract

Background

We hypothesized that colectomy for fulminant Clostridium difficile colitis (CDC) before organ failure would be associated with decreased mortality.

Methods

Data were retrospectively collected on patients operated on for CDC between 2000 and 2007. Variables examined included age, sex, immunodeficiency, recurrent CDC, vasopressor requirement, acute respiratory failure, acute renal failure, white blood cell count, and stress ulcer prophylaxis. Univariate and multivariate analyses were performed to identify predictors of mortality.

Results

During this period, 6,841 patients were diagnosed with CDC and 69 patients underwent surgery. Independent predictors of mortality were age >65 years (odds ratio [OR] 6.8, confidence interval [CI] 1.4–32.3, P = .016), acute respiratory failure (OR 5.4, CI 1.6–18.1, P = .007), and acute renal failure (OR 3.8, CI 1.1–13.1, P = .035).

Conclusions

Colectomy before the development of organ failure is associated with decreased mortality in patients with fulminant CDC, especially in those >65 years old.

Keywords: Clostridium difficile, Colectomy, Colitis, Mortality, Survival