A Comparison of Partial and Total Colectomy in the Surgical Management of Clostridium Difficile Colitis
*David Peprah, *Alexander S Chiu, Raymond A Jean, Kevin Y Pei
Yale School of Medicine, New Haven, CT
Objective: Surgical management can be indicated for severe, complicated Clostridium Difficile Associated Disease (CDAD). Practice guidelines suggest that sub-total colectomy should be the mainstay of surgical treatment, given the widespread involvement of colonic structures. However, small studies have suggested partial colectomy may provide equivalent outcomes. We compared the outcomes of partial and sub-total colectomy for CDAD in a nationwide database.
Design: Retrospective study using the American College of Surgeons National Surgical Quality Improvement Project (NSQIP).
Setting: NSQIP hospitals between 2007-2015.
Patients: Patients with a primary diagnosis of Clostridium Difficile colitis who underwent an emergent sub-total or partial colectomy.
Main Outcome Measures: Postoperative mortality rate, complication rate, and length of stay.
Results: There were 733 colectomies for CDAD identified, of which 151 (20.6%) were partial colectomies. There was no significant difference in patient demographics or clinical status of those receiving partial or sub-total colectomies, and no difference in days from admission to surgery (4.6 days for partial vs. 5.0 for sub-total, p=0.70). Logistic regression controlling for patient demographics and clinical factors demonstrated there was no statistically significant difference for partial colectomy in 30-day mortality (OR 1.21 95%CI 0.76-1.96) or complication rate (OR 0.92 95%CI 0.51-1.62) compared to total colectomy. Sub-total colectomy trended towards longer postoperative stay (18.0 vs. 15.1 days for partial, p=0.08).
Conclusions: In a national database, a significant percent of patients with CDAD underwent partial colectomies, against guideline recommendations. There were no significant differences found in mortality or complications between partial and sub-total colectomy for CDAD.
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