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 - 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
SN - 0002-9610
VL - 217
SP - 1042
EP - 1046
JO - American journal of surgery
JF - American journal of surgery
IS - 6
ER -