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News

Score predicts mortality after colectomy for Clostridium difficile

A surgical Clostridium-associated risk of death score predicts mortality after colectomy for Clostridium difficile, reports the latest issue of the Diseases of the Colon & Rectum.

News image

A Clostridium difficile-associated risk of death score was recently developed and validated by using a national cohort of both nonsurgical and surgical patients admitted with Clostridium difficile infection.

However, risk scores specifically derived from surgical cohorts and designed for patients with Clostridium difficile infection are currently unavailable.

Dr Audrey Kulaylat and colleagues developed a risk of death score for patients with Clostridium difficile infection who are being considered for total abdominal colectomy because of the failure of medical therapy.

The research team performed a retrospective cohort study, conducted with the use of a national database.

All patients undergoing total colectomy for Clostridium difficile infection were identified in the National Surgical Quality Improvement Program database from 2005 to 2014.

33% experienced 30-day postoperative mortality
Diseases of the Colon & Rectum

Variables similar to the original scoring system were used in multivariable analyses to determine the risk of 30-day mortality for patients, and a model was constructed to estimate the predicted probability of mortality after surgery.

Of 532 patients who underwent surgery, the team found that 33% experienced 30-day postoperative mortality.

The researchers observed that patient covariates associated with significantly increased mortality included age greater than 80 years, need for preoperative mechanical ventilation, chronic steroid use, underlying cardiopulmonary disease, and acute renal failure.

These and other comorbidities, including hepatic disease, a cancer diagnosis, and both insulin- and noninsulin-dependent diabetes mellitus, were used to construct a model to estimate the predicted probability of mortality, which ranged from 8% to 96% based on individual comorbidity profiles.

These estimates differed substantially when compared with those obtained using the National Surgical Quality Improvement Program risk calculator, which estimated the risk of mortality among surgical patients as being consistently lower.

Dr Kulaylat's team concludes, "Our surgical scoring system allows preoperative risk stratification for patients being evaluated for colectomy for Clostridium difficile infection, potentially helping to avoid futile surgery."

Dis Colon Rectum 2017: 60(12): 1285–1290
29 November 2017

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