Predictors of Mortality After Emergency Colectomy for Clostridium Difficile Colitis An Analysis of ACS-NSQIP

Objective: To evaluate clinical factors associated with mortality in emergency colectomies performed for Clostridium difficile colitis. Background: The incidence and mortality from C difficile colitis is on the rise. Emergent colectomy performed for C difficile colitis is associated with a high mortality. Methods: The ACS-NSQIP database from 2005 to 2010 was used to study emergently performed open colectomies for a primary diagnosis of C difficile colitis on the International Classification of Diseases, Ninth Revision. Preoperative, intraoperative, and postoperative factors were noted and compared between survivors and nonsurvivors. We performed multivariate stepwise binomial logistic regression analyses to study clinical factors that may be associated with 30-day mortality. Results: The overall mortality for this cohort was 33% (111/335) with a median time to death of 8 days. On average, survivors were discharged on postoperative day 24. On multivariate analysis, those aged 80 years or older were associated with a ninefold increase in the odds of mortality [95% confidence interval (CI): 3.0-13.0]. Other factors associated with increased mortality were preoperative shock (OR = 2.8, 95% CI: 1.6-5.4), preoperative dialysis dependence (OR = 2.3, 95% CI: 1.1-4.8), chronic obstructive pulmonary disease (OR = 3.7, 95% CI: 2.0-7.1), and wound class III (OR = 2.1, 95% CI: 3.0-13). Thrombocytopenia (platelet count < 150 x 10(3)/mm(3)), coagulopathy (International Normalized Ratio >2.0), and renal insufficiency (blood urea nitrogen > 40 mg/dL) were associated with a higher mortality as well. Conclusions: This is the largest series of colectomies performed for C difficile colitis in the literature. We identified several preoperative clinical risk factors that were associated with increased postoperative mortality. These findings may be useful in selecting appropriate patients for surgical intervention and may help to define a population where surgery may not be beneficial.