Postoperative diarrhea and high ostomy output impact postoperative outcomes after elective colon and rectal operations regardless of Clostridium difficile infection

Abstract Background We aimed to review and compare outcomes of patients with and without Clostridium difficile infection (CDI) after elective colorectal operations. Methods Retrospective cohort study of patients with CDI after elective colon and rectal operations from 2007 to 2012 (Group A) was cond...

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Bibliographic Details
Published in:The American journal of surgery 2015-10, Vol.210 (4), p.759-765
Main Authors: Gaertner, Wolfgang B., M.Sc., M.D, Madoff, Robert D., M.D, Mellgren, Anders, M.D., Ph.D, Kwaan, Mary R., M.D., M.P.H, Melton, Genevieve B., M.D., Ph.D
Format: Article
Language:English
Subjects:
Abdomen
Age
Aged
Aged, 80 and over
Antibiotic Prophylaxis
Antibiotics
Clostridium difficile
Clostridium Infections - diagnosis
Clostridium Infections - epidemiology
Colectomy
Colorectal
Colostomy
Demographics
Diarrhea
Diarrhea - microbiology
Elective Surgical Procedures - adverse effects
Female
High stoma output
Hospitalization
Hospitals
Humans
Ileostomy
Infections
Inflammatory bowel disease
Intestinal Diseases - microbiology
Intestinal Diseases - pathology
Intestinal Diseases - surgery
Laparoscopy
Laparoscopy - adverse effects
Male
Medical records
Middle Aged
Mortality
Ostomy
Postoperative
Retrospective Studies
Risk factors
Surgery
Surgical Wound Infection - epidemiology
Surgical Wound Infection - microbiology
Treatment Outcome
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Summary:Abstract Background We aimed to review and compare outcomes of patients with and without Clostridium difficile infection (CDI) after elective colorectal operations. Methods Retrospective cohort study of patients with CDI after elective colon and rectal operations from 2007 to 2012 (Group A) was conducted. Outcomes were compared with patients with a negative C. difficile toxin assay performed for postoperative diarrhea or high stoma output (Group B) and matched controls (Group C). Results Forty-four patients (median age 53 years) developed CDI postoperatively (Group A). Fourteen patients (32%) had surgical site infections. Both Group A and Group B patients received ertapenem as preoperative antibiotic prophylaxis significantly more often than matched controls ( P  < .0001), and also had significantly more surgical site infections ( P = .004), longer hospital stays ( P = .003), and more readmissions ( P = .02) compared with Group C patients. Conclusions In this study, postoperative CDI was uncommon, of low morbidity, and no mortality. Postoperative diarrhea and high stoma output, whether in patients who are C. difficile positive or not, appear to impact postoperative outcomes.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2015.03.032