No survival advantage exists for patients undergoing loop ileostomy for clostridium difficile colitis

Bradley R. Hall, Jennifer A Leinicke, Priscila R. Armijo, Lynette M Smith, Sean J Langenfeld, Dmitry Oleynikov

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: We aim to compare outcomes between loop ileostomy (LI) and total abdominal colectomy (TAC) for clostridium difficile infection (CDI) and hypothesize that LI is associated with fewer complications. Methods: The 2011–2016 ACS-NSQIP database was queried for patients undergoing LI or TAC for CDI. Patients with high outlying age, LOS, and operative time were excluded. Statistics were performed using IBM-SPSS and NCSS PASS-11. Results: Of 457 patients identified, 47 underwent LI. Predicted morbidity was higher in the TAC cohort (62% vs. 37%, p < 0.001). Patients in the LI cohort experienced fewer complications (72% vs. 87%, p = 0.021); however, mortality did not differ between LI (36%) and TAC (31%). Blood transfusions were more than twice as frequent in the TAC cohort (54% vs. 19%, p < 0.001). Four patients in the LI cohort required reoperation; however, none required colectomy. Conclusions: No mortality difference was observed between LI and TAC. Prospective studies are required to determine the utility of LI. An analysis of the ACS-NSQIP database was performed and demonstrates that no survival benefit exists for patients who undergo loop ileostomy for C difficile infection compared to those who undergo total colectomy; however, patients who undergo loop ileostomy are likely to retain their colon with low risk of requiring subsequent colectomy.

Original languageEnglish (US)
Pages (from-to)34-39
Number of pages6
JournalAmerican journal of surgery
Volume217
Issue number1
DOIs
StatePublished - Jan 2019

Fingerprint

Ileostomy
Clostridium difficile
Colitis
Colectomy
Survival
Clostridium Infections
Databases
Mortality
Operative Time
Reoperation
Blood Transfusion
Colon
Prospective Studies

Keywords

  • Clostridium difficile infection
  • Colectomy
  • Colon
  • Loop ileostomy
  • Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

No survival advantage exists for patients undergoing loop ileostomy for clostridium difficile colitis. / Hall, Bradley R.; Leinicke, Jennifer A; Armijo, Priscila R.; Smith, Lynette M; Langenfeld, Sean J; Oleynikov, Dmitry.

In: American journal of surgery, Vol. 217, No. 1, 01.2019, p. 34-39.

Research output: Contribution to journalArticle

@article{af33d8efa4294029961c3466cc299b69,
title = "No survival advantage exists for patients undergoing loop ileostomy for clostridium difficile colitis",
abstract = "Background: We aim to compare outcomes between loop ileostomy (LI) and total abdominal colectomy (TAC) for clostridium difficile infection (CDI) and hypothesize that LI is associated with fewer complications. Methods: The 2011–2016 ACS-NSQIP database was queried for patients undergoing LI or TAC for CDI. Patients with high outlying age, LOS, and operative time were excluded. Statistics were performed using IBM-SPSS and NCSS PASS-11. Results: Of 457 patients identified, 47 underwent LI. Predicted morbidity was higher in the TAC cohort (62{\%} vs. 37{\%}, p < 0.001). Patients in the LI cohort experienced fewer complications (72{\%} vs. 87{\%}, p = 0.021); however, mortality did not differ between LI (36{\%}) and TAC (31{\%}). Blood transfusions were more than twice as frequent in the TAC cohort (54{\%} vs. 19{\%}, p < 0.001). Four patients in the LI cohort required reoperation; however, none required colectomy. Conclusions: No mortality difference was observed between LI and TAC. Prospective studies are required to determine the utility of LI. An analysis of the ACS-NSQIP database was performed and demonstrates that no survival benefit exists for patients who undergo loop ileostomy for C difficile infection compared to those who undergo total colectomy; however, patients who undergo loop ileostomy are likely to retain their colon with low risk of requiring subsequent colectomy.",
keywords = "Clostridium difficile infection, Colectomy, Colon, Loop ileostomy, Mortality",
author = "Hall, {Bradley R.} and Leinicke, {Jennifer A} and Armijo, {Priscila R.} and Smith, {Lynette M} and Langenfeld, {Sean J} and Dmitry Oleynikov",
year = "2019",
month = "1",
doi = "10.1016/j.amjsurg.2018.09.023",
language = "English (US)",
volume = "217",
pages = "34--39",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - No survival advantage exists for patients undergoing loop ileostomy for clostridium difficile colitis

AU - Hall, Bradley R.

AU - Leinicke, Jennifer A

AU - Armijo, Priscila R.

AU - Smith, Lynette M

AU - Langenfeld, Sean J

AU - Oleynikov, Dmitry

PY - 2019/1

Y1 - 2019/1

N2 - Background: We aim to compare outcomes between loop ileostomy (LI) and total abdominal colectomy (TAC) for clostridium difficile infection (CDI) and hypothesize that LI is associated with fewer complications. Methods: The 2011–2016 ACS-NSQIP database was queried for patients undergoing LI or TAC for CDI. Patients with high outlying age, LOS, and operative time were excluded. Statistics were performed using IBM-SPSS and NCSS PASS-11. Results: Of 457 patients identified, 47 underwent LI. Predicted morbidity was higher in the TAC cohort (62% vs. 37%, p < 0.001). Patients in the LI cohort experienced fewer complications (72% vs. 87%, p = 0.021); however, mortality did not differ between LI (36%) and TAC (31%). Blood transfusions were more than twice as frequent in the TAC cohort (54% vs. 19%, p < 0.001). Four patients in the LI cohort required reoperation; however, none required colectomy. Conclusions: No mortality difference was observed between LI and TAC. Prospective studies are required to determine the utility of LI. An analysis of the ACS-NSQIP database was performed and demonstrates that no survival benefit exists for patients who undergo loop ileostomy for C difficile infection compared to those who undergo total colectomy; however, patients who undergo loop ileostomy are likely to retain their colon with low risk of requiring subsequent colectomy.

AB - Background: We aim to compare outcomes between loop ileostomy (LI) and total abdominal colectomy (TAC) for clostridium difficile infection (CDI) and hypothesize that LI is associated with fewer complications. Methods: The 2011–2016 ACS-NSQIP database was queried for patients undergoing LI or TAC for CDI. Patients with high outlying age, LOS, and operative time were excluded. Statistics were performed using IBM-SPSS and NCSS PASS-11. Results: Of 457 patients identified, 47 underwent LI. Predicted morbidity was higher in the TAC cohort (62% vs. 37%, p < 0.001). Patients in the LI cohort experienced fewer complications (72% vs. 87%, p = 0.021); however, mortality did not differ between LI (36%) and TAC (31%). Blood transfusions were more than twice as frequent in the TAC cohort (54% vs. 19%, p < 0.001). Four patients in the LI cohort required reoperation; however, none required colectomy. Conclusions: No mortality difference was observed between LI and TAC. Prospective studies are required to determine the utility of LI. An analysis of the ACS-NSQIP database was performed and demonstrates that no survival benefit exists for patients who undergo loop ileostomy for C difficile infection compared to those who undergo total colectomy; however, patients who undergo loop ileostomy are likely to retain their colon with low risk of requiring subsequent colectomy.

KW - Clostridium difficile infection

KW - Colectomy

KW - Colon

KW - Loop ileostomy

KW - Mortality

UR - http://www.scopus.com/inward/record.url?scp=85058472737&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058472737&partnerID=8YFLogxK

U2 - 10.1016/j.amjsurg.2018.09.023

DO - 10.1016/j.amjsurg.2018.09.023

M3 - Article

C2 - 30266417

AN - SCOPUS:85058472737

VL - 217

SP - 34

EP - 39

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 1

ER -