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John C. Byrn, MD; Dipen C. Maun, MD; Daniel S. Gingold, MD; Donald T. Baril, MD; Junko J. Ozao, MD; Celia M. Divino, MD

Arch Surg. 2008;143(2):150-154.

Objectives  To present, to our knowledge, the largest experience with colectomy for fulminant Clostridium difficile colitis and to propose factors significant in predicting mortality.

Design  Retrospective medical record review.

Setting  University teaching hospital.

Patients  Seventy-three patients undergoing colectomy between 1994 and 2005 for C difficile–associated pseudomembranous colitis.

Main Outcome Measures  Preoperative predictors of in-hospital mortality.

Results  Seventy-three of 5718 cases (1.3%) of C difficile colitis required colectomy. Mean age was 68 years. In-hospital mortality was 34% (n = 25). Eighty-six percent (n = 63) of patients received a subtotal colectomy. Patients presented with diarrhea (84%; n = 61), abdominal pain (75%; n = 55), and ileus (16%; n = 12). Mean duration of symptoms was 7 days followed by 4 days of medical treatment prior to colectomy. On univariate analysis, an admitting diagnosis other than C difficile (P = .049), vasopressor requirement (P = .001), intubation (P = .001), and mental status changes (P < .001) were significant predictors of mortality. Arterial lactate level (4.9 vs 2.4 mmol/L; P = .007) was significantly higher and length of medical management (6.4 vs 3.0 days; P = .006) was significantly longer in the mortality group. Platelet counts (169 x 10³/µL vs 261 x 10³/µL [to convert to x 10⁹/L, multiply by 1]; P = .04) were significantly lower in the mortality group. On multivariate analysis, vasopressor requirement (P = .04; odds ratio, 5.0), mental status changes (P = .002; odds ratio, 12.6), and treatment length (P = .002; odds ratio, 1.4) remained significant predictors of mortality.

Conclusions  Colectomy for C difficile colitis carries a substantial mortality regardless of patient age and white blood cell count. Preoperative vasopressor requirement, mental status changes, and length of medical treatment significantly predict mortality.

Author Affiliations: Departments of Surgery, Mount Sinai School of Medicine, New York (Drs Byrn, Maun, Baril, Ozao, and Divino), and Albert Einstein School of Medicine, Montefiore Medical Center, Bronx (Dr Gingold), New York.

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