To present, to our knowledge, the largest experience with colectomy for fulminant Clostridium difficile colitis and to propose factors significant in predicting mortality.
Retrospective medical record review.
University teaching hospital.
Seventy-three patients undergoing colectomy between 1994 and 2005 for C difficile–associated pseudomembranous colitis.
Main Outcome Measures
Preoperative predictors of in-hospital mortality.
Seventy-three of 5718 cases (1.3%) of C difficile colitis required colectomy. Mean age was 68 years. In-hospital mortality was 34% (n = 25). Eighty-six percent (n = 63)
of patients received a subtotal colectomy. Patients presented with diarrhea (84%; n = 61), abdominal pain (75%; n = 55),
and ileus (16%; n = 12). Mean duration of symptoms was 7
days followed by 4 days of medical treatment prior to colectomy. On univariate analysis, an admitting diagnosis other than C difficile (P = .049),
vasopressor requirement (P = .001),
intubation (P = .001), and mental status changes (P < .001) were significant predictors of mortality. Arterial lactate level (4.9 vs 2.4 mmol/L; P = .007) was significantly higher and length of medical management (6.4 vs 3.0 days; P = .006) was significantly longer in the mortality group. Platelet counts (169 × 103/μL vs 261 × 103/μL [to convert to × 109/L, multiply by 1]; P = .04) were significantly lower in the mortality group. On multivariate analysis, vasopressor requirement (P = .04; odds ratio, 5.0), mental status changes (P = .002; odds ratio,
12.6), and treatment length (P = .002;
odds ratio, 1.4) remained significant predictors of mortality.
Colectomy for C difficile colitis carries a substantial mortality regardless of patient age and white blood cell count. Preoperative vasopressor requirement, mental status changes,
and length of medical treatment significantly predict mortality.