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Early Colectomy Saves Lives in Toxic Megacolon Due to Clostridium difficile Infection

Clostridium difficile infection occasionally presents with one of the fulminant toxic colon conditions that results in rapid deterioration of a patient’s condition. Approximately 3% to 4% of patients infected with C. difficile progress to the fulminant course and can result in sepsis and septic shock. In most circumstances, conservative management has failed to improve a patient’s condition and often has led to multiple organ failure and death. Early operative intervention can result in survival benefit. Abstract Objective The purpose of the study was to evaluate whether early colectomy in patients who have toxic megacolon due to Clostridium difficile colitis reduces mortality. Methods The study was performed using the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2016. All patients 18 to 89 years of age who underwent colectomy for toxic megacolon resulting from C. difficile colitis were included in the study. Other variables included in the study were patient demography, comorbidities, and outcomes. Patients who underwent colectomy before the presentation of septic shock (early group) were compared with patients who underwent colectomy after the onset of septic shock (late group). The main outcome of the study is 30-day all-cause mortality. Because there were some significant differences found in patient baseline characteristics in the univariate analysis, the propensity score of each patient was calculated and pair-matched analysis was performed. All P values are reported as 2-sided, and P < 0.05 was considered statistically significant. Results One hundred sixty-three patients met the inclusion criteria of the study. Approximately 85% of the patients underwent total abdominal colectomy. The average age of the patients was 65 years old, 51% of the patients were female, and 66% of the patients were white. The overall 30-day mortality was approximately 39%. The mortality rate of patients who underwent colectomy early compared to late was 13 (21%) vs 28 (45%), P = 0.009. The absolute risk difference was 0.24 with 95% CI: 0.07–0.42. Conclusions There was a reduction of 24% in 30-day mortality when colectomies were performed before the development of septic shock.