Factors that predict clinical outcome after colectomy for fulminant Clostridium difficile colitis

Background: Historically, the incidence of C. difficile-associated colitis has increased significantly over the last decade. Of these patients, approximately 10% - 20% will ultimately require colectomy due to fulminant disease and progression to toxic colitis. Despite operative intervention, the mortality for this population remains high (35% - 80%). This study evaluates for preoperative risk factors for mortality. Methods: Retrospective medical record review of 47 patients who underwent emergent colectomy for fulminant C. ddifficile colitis over a five-year period at three teaching hospitals in New York City. Results: Forty-seven patients with Clostridium difficile colitis underwent colectomy from January 2003 to December 2008. The mean age was 66 years with 31 (67%) male and 16 (34%) female. The 30-day mortality was 34% (16/47 patients). Thirty-eight (81%) underwent subtotal colectomy, six (13%) Hartmann resection, two (4%) right hemicolectomy, and one (2%) underwent left colectomy. Univariate analysis showed that age (71.6 vs. 67.5 years; p = 0.402), white blood cell count (35,500 vs. 27,700/mm3; p = 0.271), and use of vaso-pressors in the pre-operative period *p = 0.440) were not statistically predictive of postoperative mortality. Conversely, preoperative serum lactate level (4.3 vs. 2.1 mmol/L p + 0.009) was statistically greater in the postoperative mortality group. Conclusion: In the setting of fulminant C. difficile colitis, serum lactate levels can help predict postoperative outcome following emergent colectomy and should be closely followed to facilitate the decision to proceed with surgery.