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NESS 2006 Annual Meeting
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Negative Predictors of Survival after Colectomy in Patients with Fulminant Clostridium difficile (C. Diff) colitis
Fuad Alkhoury, John Aversa, Jr., Kenneth A Ciardiello, John Bonadies, John M. Boyce, Department of Surgery and Department of Medicine
Hospital of Saint Raphael, New Haven, CT

Objective:To determine the negative predictors of survival following colectomy for fulminant C.diff colitis.
Design: Retrospective case-control study.
Setting: Non-university teaching hospital.
Patients: Sixteen patients (5 survivors and 11 non-survivors) underwent colectomy for fulminant C.diff colitis between 2002- 2006. Mean patient age was 72 years, and 87% were female.
Main Outcome Measures: Clinical parameters were collected at the first sign of significant clinical deterioration defined as worsening abdominal exam, persistent oliguria, persistent hypotension, respiratory compromise, or significant increase in the WBC. Variables were compared between survivors and non-survivors using Fishers Exact test or Mann-Whitney U test.
Results: All 16 patients had one or more risk factors for developing C.diff (antibiotic use, previous surgery, chemotherapy). Analysis revealed there were no significant differences between survivors and non-survivors for the following clinical parameters: increase or absolute WBC, serum pH, creatinine, lactate level, base deficit, anion gap, colonic wall thickening on abdominal CT scan, and frequency of clinical diagnosis of C.diff infection prior to colectomy. The median time interval between clinical deterioration and surgery was significantly shorter for survivors than for non-survivors (12hr versus 27hr, respectively, p = 0.003). There was no significant difference between survivors and non-survivors with respect to the type of colectomy performed (subtotal versus partial).
Conclusions: In patients with severe C.diff colitis, delays between clinical deterioration and surgical intervention should be avoided to maximize successful outcome of colectomy.

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