Back to Annual Meeting Posters

Objective: Several single institution studies have established the mortality associated with colectomy for severe Clostridium difficile infection (CDI). The aim of this study was to define factors impacting 30-day mortality of patients with severe CDI requiring surgical intervention.
Design: Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) participant use files from 2005-2010, patients diagnosed with Clostridium difficile infection (CDI) who underwent exploratory laparotomy, partial or total colectomy, or ostomy without resection were included in the analysis. Multivariate regression was used to compare patient demographics and their condition (pre-operatively and post-operatively) amongst survivors and non-survivors.
Main Outcome Measures: Mortality and complications within 30 days postoperatively.
Results: A total of 548 patients were identified who received surgical intervention for CDI. There were 175 (31.9%) non-survivors reported (30-day mortality). On multivariate analysis, factors predictive of mortality included advanced age, BMI, chronic steroid use, functional dependence, severe COPD, ASA status of IV or V, as well as, preoperative renal failure, dialysis, ventilator dependence, and operative time.
Postoperative complications such as transfusion requirement, cardiac arrest, coma for greater than 24 hours, ventilator dependence, septic shock, and acute renal failure were higher amongst nonsurvivors, on univariate analysis. On multivariate analysis of postoperative complications, cardiac arrest, postoperative transfusion requirement, and septic shock were independently significant for increased mortality from CDI.
Conclusions: CDI requiring surgical intervention was associated with a 32% mortality rate, which was predominant among older patients with preoperative more medical co-morbidities. Extent of surgical procedure does not influence survival. Postoperatively, cardio-pulmonary failure was associated with increased mortality.