Paper 1: Ahmed et al. Risk factors of surgical mortality in patients with Clostridium difficile colitis. A novel scoring system. Eur J Trauma Emerg Surg. 2022 Jun.
– Risk score development study using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP)
– 525 adult (18-89) patients undergoing colectomy between 2012 and 2016
– Split data into training (80%) and testing (20%) datasets
– Identified mortality risk factors to create and validate a scoring system
– Scores ranged from 0 to 37 with the highest score predicting an 83.9% risk of mortality
– This scoring system appears relatively straight-forward and methodically sound but the lack of a currently available calculator limits use to some degree
Paper 2: McKechnie et al. Total Abdominal Colectomy Versus Diverting Loop Ileostomy and Antegrade Colonic Lavage for Fulminant Clostridioides Colitis: Analysis of the National Inpatient Sample 2016-2019. J Gastrointest Surg. 2023 Apr 20.
– Retrospective cohort study of adults (18+) in the National Inpatient Sample (NIS) admitted between Jan 2016 and Dec 2019 for C. difficile colitis, undergoing either a total abdominal colectomy (TAC) or diverting loop ileostomy (DLI) with antegrade vancomycin enemas
– Focus on not only mortality and complications but also admission cost and length of stay
– 886 TAC and 409 DLI patients were identified
– Multivariable logistic regression analysis showed no difference in mortality or overall complications
– TAC patients had shorter admissions (mean difference 4.06 days) and lower cost (mean difference $79,715.34)
– Study was limited as it considered only the initial admission and is unable to provide data on outcomes and costs beyond this time
– Furthermore, there is consideration for disease severity in the analysis, which may impede the ability to compare the two operative approaches
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