Predicting Colectomy and Post-Op Mortality in C. Difficile Colitis Patients

Epidemiologists have been documenting an increasing incidence of Clostridium difficile colitis (CDC) in the United States, and many affected patients must undergo total colectomy.

To analyze the risk factors for colectomy and post-operative mortality among those patients, surgeons from the University of California, Irvine School of Medicine retrospectively reviewed the Nationwide Inpatient Sample (NIS) between 2001 and 2010 for CDC trends.

During the 10-year review period, more than 2.7 million hospital discharges with a diagnosis of CDC were identified. The researchers found that colectomy was needed in 0.7% of those patients, among whom roughly 1 in 3 died.

The authors identified coagulopathy (OR 2.71), weight loss (OR 2.25), admission to teaching hospitals (OR 1.37), fluid or electrolyte disorders (OR 1.31), and admission to large hospitals (OR 1.18) as predictors for colectomy. Risk factors for mortality after colectomy included coagulopathy (odds ratio [OR] 2.38), age older than 60 years (OR 1.97), acute renal failure (OR 1.67), respiratory failure (OR 1.61), sepsis (OR 1.40), peripheral vascular disease (OR 1.39), and congestive heart failure (OR 1.25). In addition, surgery performed more than 3 days after admission was associated with higher mortality rates (OR 1.09).

The study also identified protective factors for CDC patients requiring colectomy, such as obesity, hypothyroidism, depression, deficiency anemia, drug abuse, weight loss, and blood loss anemia.

The researchers advised clinicians who are aware of specific predisposing patient and hospital factors to apply their knowledge in order to risk-stratify and counsel CDC patients appropriately. Those at highest risk should be quickly referred for colectomy.