Many hospitals in Canada have noted since 2003 a dramatic increase in Clostridium difficile-associated disease incidence.
The proportion of cases was severe enough to require intensive care unit admission.
The decision to perform an emergency colectomy remains largely empirical.
Dr Francois Lamontagne and colleagues from Canada determined whether emergency colectomy reduces mortality in fulminant Clostridium difficile-associated disease.
The team of doctors identified subgroups of patients more likely to benefit from the procedure.
The doctors conducted a retrospective observational cohort study of 165 cases of Clostridium difficile-associated disease.
|53% of cases died within 30 days of intensive care unit admission
|Annals of Surgery|
The patients required intensive care unit admission or prolongation of intensive care unit stay between 2003 and 2005 in 2 tertiary care hospitals.
The team performed multivariate analysis through logistic regression.
Adjusted odds ratios and their 95% confidence intervals were calculated.
The primary outcome was mortality within 30 days of intensive care unit admission.
The doctors found that 53% of cases resulted in death within 30 days of intensive care unit admission.
Almost half of the mortalities occurred within 48 hours of intensive care unit admission.
The independent predictors of 30-day mortality were leukocytosis 50 x 109/L or more, lactate 5 mmol/L or more, and age 75 years or above.
The doctors observed that immunosuppression was an independent predictor of 30-day mortality.
Shock requiring vasopressors also independently predicted 30-day mortality.
After adjustment for these confounders, the team found that patients who had an emergency colectomy were less likely to die than those treated medically.
Colectomy seemed more beneficial in patients aged 65 years or more, and in those immunocompetent.
In addition, the doctors noted that colectomy was more beneficial in those with a leukocytosis 20 x 109/L or more, and lactate between 2 and 5 mmol/L .
Dr Lamontagne's team concludes, “Emergency colectomy reduces mortality in some patients with fulminant Clostridium difficile-associated disease.”