Diverting loop ileostomy versus total abdominal colectomy for clostridioides difficile colitis: outcomes beyond the index admission.
Clostridioides difficile
Colon preserving option
Diverting loop ileostomy
Emergency colectomy
Total abdominal colectomy
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
10
01
2020
accepted:
22
06
2020
pubmed:
1
7
2020
medline:
30
9
2021
entrez:
1
7
2020
Statut:
ppublish
Résumé
Diverting loop ileostomy (DLI) and colonic lavage has emerged as a valid alternative to total abdominal colectomy (TAC) for the surgical management of Clostridioides difficile colitis (CDC). However, little data are available on outcomes beyond the index admission. The objective of this study was to compare post-discharge outcomes between patients who underwent DLI and TAC for CDC. Adult patients who underwent DLI or TAC for CDC between 2011 and 2016 were identified from the Nationwide Readmissions Database, and only discharges between January and September in each calendar year were included to allow for a 90-day follow-up period for all cases. Ninety-day overall in-hospital mortality (index admission mortality plus 90-day post-discharge mortality) and 90-day unplanned readmissions were compared. To assess 6-month ileostomy reversal rates, the cohort was then truncated to exclude discharges after June in each calendar year. Multivariate regression was used to adjust for patient demographics and disease severity. In total, 2070 patients were discharged between January and September of each included year: 1486 (71.8%) TAC compared to 584 (28.2%) DLI. Overall in-hospital mortality was higher among patients who underwent TAC (34.5% vs. 27.7%, p = 0.004); however, this association did not remain on multivariate regression (OR 1.14, 95% CI 0.91-1.43). Among the 1434 patients who were discharged alive, the 90-day unplanned readmission rate was similar in both groups (TAC: 26.1% vs. DLI: 23.1%, p = 0.26). After truncating the cohort to those patients discharged alive between January and June of each included year (n = 1016), patients who underwent DLI had a significantly greater 6-month ileostomy reversal rate (26.4% vs. 8.3%, p < 0.001). DLI was independently associated with higher odds of 6-month ileostomy reversal (OR 2.68, 95% CI 1.80-4.00). In the surgical management of CDC, DLI is associated with equivalent mortality and unplanned readmission, but greater likelihood of 6-month ileostomy reversal, compared to TAC.
Identifiants
pubmed: 32601762
doi: 10.1007/s00464-020-07755-6
pii: 10.1007/s00464-020-07755-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3147-3153Références
Foster NF, Collins DA, Ditchburn SL et al (2014) Epidemiology of Clostridium difficile infection in two tertiary-care hospitals in Perth, Western Australia: a cross-sectional study. New Microbes New Infect 2(3):64–71
doi: 10.1002/nmi2.43
Cioni G, Viale P, Frasson S et al (2016) Epidemiology and outcome of Clostridium difficile infections in patients hospitalized in internal medicine: findings from the nationwide FADOI-PRACTICE study. BMC Infect Dis 16(1):656
doi: 10.1186/s12879-016-1961-9
Sartelli M, Malangoni MA, Abu-Zidan FM et al (2015) WSES guidelines for management of Clostridium difficile infection in surgical patients. World J Emerg Surg 10:38
doi: 10.1186/s13017-015-0033-6
Delano MJ, Cuschieri J (2016) Surgical management of Clostridium difficile infection: the role of colectomy. Surg Infect (Larchmt) 17(3):343–345
doi: 10.1089/sur.2016.004
Sailhamer EA, Carson K, Chang Y et al (2009) Fulminant Clostridium difficile colitis: patterns of care and predictors of mortality. Arch Surg 144(5):433–439. discussion 9–40
doi: 10.1001/archsurg.2009.51
Dallas KB, Condren A, Divino CM (2014) Life after colectomy for fulminant Clostridium difficile colitis: a 7-year follow up study. Am J Surg 207(4):533–539
doi: 10.1016/j.amjsurg.2013.04.008
Lamontagne F, Labbe AC, Haeck O et al (2007) Impact of emergency colectomy on survival of patients with fulminant Clostridium difficile colitis during an epidemic caused by a hypervirulent strain. Ann Surg 245(2):267–272
doi: 10.1097/01.sla.0000236628.79550.e5
Neal MD, Alverdy JC, Hall DE, Simmons RL, Zuckerbraun BS (2011) Diverting loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for the treatment of severe, complicated Clostridium difficile associated disease. Ann Surg 254(3):423–427. discussion 7–9
doi: 10.1097/SLA.0b013e31822ade48
Ferrada P, Callcut R, Zielinski MD et al (2017) Loop ileostomy versus total colectomy as surgical treatment for Clostridium difficile-associated disease: an Eastern Association for the Surgery of Trauma multicenter trial. J Trauma Acute Care Surg 83(1):36–40
doi: 10.1097/TA.0000000000001498
Hall BR, Leinicke JA, Armijo PR, Smith LM, Langenfeld SJ, Oleynikov D (2019) No survival advantage exists for patients undergoing loop ileostomy for Clostridium difficile colitis. Am J Surg 217(1):34–39
doi: 10.1016/j.amjsurg.2018.09.023
Juo YY, Sanaiha Y, Jabaji Z, Benharash P (2019) Trends in diverting loop ileostomy vs total abdominal colectomy as surgical management for Clostridium difficile Colitis. JAMA Surg 154(10):899–906
doi: 10.1001/jamasurg.2019.2141
Fashandi AZ, Martin AN, Wang PT et al (2017) An institutional comparison of total abdominal colectomy and diverting loop ileostomy and colonic lavage in the treatment of severe, complicated Clostridium difficile infections. Am J Surg 213(3):507–511
doi: 10.1016/j.amjsurg.2016.11.036
Mujahid P, Elsadig O, Joyce WP (2003) Mortality, morbidity and functional outcome after ileorectal anastomosis (Br J Surg 2003; 90: 59–65). Br J Surg 90(5):593–594
doi: 10.1002/bjs.4228
Bradburn DM, Gunn A (1992) Morbidity and function after colectomy with ileorectal anastomosis or restorative proctocolectomy for familial adenomatous polyposis. Br J Surg 79(1):90
doi: 10.1002/bjs.1800790136
Madden MV, Neale KF, Nicholls RJ et al (1991) Comparison of morbidity and function after colectomy with ileorectal anastomosis or restorative proctocolectomy for familial adenomatous polyposis. Br J Surg 78(7):789–792
doi: 10.1002/bjs.1800780708
Uzzan M, Cosnes J, Amiot A et al (2017) Long-term follow-up after ileorectal anastomosis for ulcerative colitis: a GETAID/GETAID Chirurgie Multicenter Retrospective Cohort of 343 patients. Ann Surg 266(6):1029–1034
doi: 10.1097/SLA.0000000000002022
https://www.hcup-us.ahrq.gov/db/nation/nis/APR-DRGsV20MethodologyOverviewandBibliography.pdf . Accessed 25 May 2020
Baram D, Daroowalla F, Garcia R et al (2008) Use of the all patient refined-diagnosis related group (APR-DRG) risk of mortality score as a severity adjustor in the medical ICU. Clin Med Circ Respirat Pulm Med 2:19–25
pubmed: 21157518
pmcid: 2990229
De Marco MF, Lorenzoni L, Addari P, Nante N (2002) Evaluation of the capacity of the APR-DRG classification system to predict hospital mortality. Epidemiol Prev 26(4):183–190
pubmed: 12408005
McCormick PJ, Lin HM, Deiner SG, Levin MA (2018) Validation of the all patient refined diagnosis related group (APR-DRG) risk of mortality and severity of illness modifiers as a measure of perioperative risk. J Med Syst 42(5):81
doi: 10.1007/s10916-018-0936-3
Elton C, Makin G, Hitos K, Cohen CR (2003) Mortality, morbidity and functional outcome after ileorectal anastomosis. Br J Surg 90(1):59–65
doi: 10.1002/bjs.4005
https://clinicaltrials.gov/ct2/show/NCT01441271?term=ileostomy&cond=clostridium+difficile&cntry=US&draw=2&rank=1 . Accessed 17 Nov 2019
https://clinicaltrials.gov/ct2/show/NCT02347280?term=clostridium&cond=loop+ileostomy&draw=2&rank=1 . Accessed Nov 2017
Skancke M, Vaziri K, Umapathi B, Amdur R, Radomski M, Obias V (2018) Elective stoma reversal has a higher incidence of postoperative Clostridium difficile infection compared with elective colectomy: an analysis using the American College of Surgeons National Surgical Quality Improvement Program and targeted colectomy databases. Dis Colon Rectum 61(5):593–598
doi: 10.1097/DCR.0000000000001041