TY - JOUR
T1 - Prolonged non-operative management of clostridium difficile colitis is associated with increased mortality, complications, and cost
AU - Hall, Bradley R.
AU - Armijo, Priscila R.
AU - Leinicke, Jennifer A.
AU - Langenfeld, Sean J.
AU - Oleynikov, Dmitry
N1 - Funding Information:
Funding for this study was provided by the Center for Advanced Surgical Technology at the University of Nebraska Medical Center . BRH generated the research question and is responsible for methods, and writing of manuscript. PRA was ultimately responsible for all statistical analyses. JAL, SJL, and DO provided clinical expertise. DO oversaw the project and, edited the final manuscript, and is responsible for article submission.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/6
Y1 - 2019/6
N2 - Background: We aim to investigate the effects of delaying surgery on outcomes and cost in patients admitted with severe clostridium difficile infection (CDI). Methods: The Vizient database was queried for patients with CDI who underwent open total abdominal colectomy (TAC). Patients operated on the day of admission were excluded. Chi-square, Fisher's exact, student T-test, and logistic regression were performed with α = 0.05. Results: Logistic regression analyses using days from admission to surgery (DATO), age, race, and gender demonstrated that increased DATO was associated with higher 30-day mortality (OR 1.022, 95% CI 1.001–1.044, p = 0.040), overall complications (OR 1.034, 95% CI 1.014–1.054, p = 0.001), and infectious complications (OR 1.040, 95% CI 1.018–1.062, p < 0.001)compared to age for all three outcomes. Total length of stay (LOS), intensive care unit LOS, and direct cost increased in conjunction with DATO (p < 0.001). Conclusions: Early surgical intervention in appropriately selected patients should be considered when there is a high suspicion for prolonged non-operative treatment.
AB - Background: We aim to investigate the effects of delaying surgery on outcomes and cost in patients admitted with severe clostridium difficile infection (CDI). Methods: The Vizient database was queried for patients with CDI who underwent open total abdominal colectomy (TAC). Patients operated on the day of admission were excluded. Chi-square, Fisher's exact, student T-test, and logistic regression were performed with α = 0.05. Results: Logistic regression analyses using days from admission to surgery (DATO), age, race, and gender demonstrated that increased DATO was associated with higher 30-day mortality (OR 1.022, 95% CI 1.001–1.044, p = 0.040), overall complications (OR 1.034, 95% CI 1.014–1.054, p = 0.001), and infectious complications (OR 1.040, 95% CI 1.018–1.062, p < 0.001)compared to age for all three outcomes. Total length of stay (LOS), intensive care unit LOS, and direct cost increased in conjunction with DATO (p < 0.001). Conclusions: Early surgical intervention in appropriately selected patients should be considered when there is a high suspicion for prolonged non-operative treatment.
KW - Clostridium difficile
KW - Colectomy
KW - Mortality
KW - Non-operative treatment
KW - Outcomes
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U2 - 10.1016/j.amjsurg.2019.01.017
DO - 10.1016/j.amjsurg.2019.01.017
M3 - Article
C2 - 30709552
AN - SCOPUS:85060639308
VL - 217
SP - 1042
EP - 1046
JO - American Journal of Surgery
JF - American Journal of Surgery
SN - 0002-9610
IS - 6
ER -