H. Aziz1, Z. Sun1, M. Adam1, J. Kim1, J. Migaly1, C. Mantyh1 1Duke University Medical Center,General Surgery,Durham, NC, USA
Introduction:
Clinical C. difficile infection ranges from asymptomatic carrier state to fulminant colitis. Total abdominal colectomy (TAC) is the standard of care for patients with fulminant colitis; however, small institutional series have suggested that segmental colectomy is a viable surgical alternative in selected patients. Our objective was to evaluate outcomes after segmental colectomy (SC) versus TAC for C. difficile colitis using a large risk-stratified national database.
Methods:
Patients undergoing SC or TAC between 2005-2013 for fulminant C. difficile colitis were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Short-term outcomes from SC vs TAC were compared after adjusting for age, race, ASA class, white blood cell count, preoperative sepsis, and ostomy creation. Moreover, adjusted analysis of outcomes of the sickest patients from these two cohorts was also performed.
Results:
Of the 746 patients undergoing colectomies for C. difficile colitis, 559 (75%) patients underwent TAC and 187 (25%) had SC. After adjustment for demographic characteristics and clinical disease severity, there were no differences between SC and TAC with regard to overall complications (OR 0.85, 95% CI 0.46-1.55, p=0.59), postoperative sepsis (OR 0.99, CI 0.56-1.77, p=0.99), hospital length of stay (-0.3 days, CI -0.9-0.5, p=0.48), or 30-day mortality (OR 0.94, CI 0.51-0.1.73, p=0.85). Among patients with sepsis or septic shock, overall complications (OR 0.78, 95% CI 0.3- 1.63, p=0.52), postoperative sepsis (OR 1.19, CI 0.63-2.27, p=0.59), hospital length of stay (-0.2 days, CI -0.4-0.1, p=.24), and 30-day mortality (0.67, CI 0.33-1.36, p=0.27) were not different between the two groups.
Conclusion:
This analysis from a multi-institutional national dataset of patients with C. difficile colitis demonstrates that segmental colectomy may be an acceptable alternative to total abdominal colectomy in patients eligible for a more limited resection for C.difficile colitis.
