Bradley R Hall1, Jennifer A Leinicke1, Priscila R Armijo2, Lynette M Smith3, Sean J Langenfeld1, Dmitry Oleynikov4. 1. College of Medicine, Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA. 2. Center for Advanced Surgical Technology, Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6245, USA. 3. College of Public Health, Department of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE, 68198-4375, USA. 4. College of Medicine, Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA; Center for Advanced Surgical Technology, Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6245, USA. Electronic address: doleynik@unmc.edu.
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. SUMMARY: 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.
BACKGROUND: We aim to compare outcomes between loop ileostomy (LI) and total abdominal colectomy (TAC) for clostridium difficileinfection (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. SUMMARY: 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.
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