A surgical Clostridium-associated risk of death score predicts mortality after colectomy for Clostridium difficile

Audrey S. Kulaylat, Zain Kassam, Christopher S. Hollenbeak, David Stewart

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: A Clostridium difficile-associated risk of death score was recently developed and validated by using a national cohort of both nonsurgical and surgical patients admitted with C difficile infection. However, risk scores specifically derived from surgical cohorts and designed for patients with C difficile infection are currently unavailable. Objective: The aim of this study was to develop a risk of death score for patients with C difficile infection who are being considered for total abdominal colectomy because of the failure of medical therapy. Design: This is a retrospective cohort study. Settings: This study was conducted with the use of a national database. Patients: All patients undergoing total colectomy for C difficile infection were identified in the National Surgical Quality Improvement Program database from 2005 to 2014. Main Outcome Measures: Variables similar to the original scoring system were used in multivariable analyses to determine the risk of 30-day mortality for patients, and a model was constructed to estimate the predicted probability of mortality after surgery. Results: Of 532 patients who underwent surgery, 32.7% experienced 30-day postoperative mortality. Patient covariates associated with significantly increased mortality included age greater than 80 years (OR 5.5, p = 0.003), need for preoperative mechanical ventilation (OR 3.1, p < 0.001), chronic steroid use (OR 2.9, p < 0.001), underlying cardiopulmonary disease (OR 2.0, p = 0.001), and acute renal failure (OR=1.7, p = 0.03). These and other comorbidities, including hepatic disease, a cancer diagnosis, and both insulin- and noninsulin-dependent diabetes mellitus, were used to construct a model to estimate the predicted probability of mortality, which ranged from 8.0% to 96.1% based on individual comorbidity profiles. These estimates differed substantially when compared with those obtained using the National Surgical Quality Improvement Program risk calculator, which estimated the risk of mortality among surgical patients as being consistently lower. Limitations: This study was limited by its retrospective design. Conclusions: Our surgical scoring system allows preoperative risk stratification for patients being evaluated for colectomy for C difficile infection, potentially helping to avoid futile surgery.

Original languageEnglish (US)
Pages (from-to)1285-1290
Number of pages6
JournalDiseases of the Colon and Rectum
Volume60
Issue number12
DOIs
StatePublished - Jan 1 2017

Fingerprint

Clostridium difficile
Clostridium
Colectomy
Mortality
Infection
Quality Improvement
Comorbidity
Databases
Type 1 Diabetes Mellitus
Artificial Respiration
Acute Kidney Injury
Type 2 Diabetes Mellitus
Cohort Studies
Retrospective Studies
Steroids
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

@article{a3c8d439b259427485344ea503874f4e,
title = "A surgical Clostridium-associated risk of death score predicts mortality after colectomy for Clostridium difficile",
abstract = "Background: A Clostridium difficile-associated risk of death score was recently developed and validated by using a national cohort of both nonsurgical and surgical patients admitted with C difficile infection. However, risk scores specifically derived from surgical cohorts and designed for patients with C difficile infection are currently unavailable. Objective: The aim of this study was to develop a risk of death score for patients with C difficile infection who are being considered for total abdominal colectomy because of the failure of medical therapy. Design: This is a retrospective cohort study. Settings: This study was conducted with the use of a national database. Patients: All patients undergoing total colectomy for C difficile infection were identified in the National Surgical Quality Improvement Program database from 2005 to 2014. Main Outcome Measures: Variables similar to the original scoring system were used in multivariable analyses to determine the risk of 30-day mortality for patients, and a model was constructed to estimate the predicted probability of mortality after surgery. Results: Of 532 patients who underwent surgery, 32.7{\%} experienced 30-day postoperative mortality. Patient covariates associated with significantly increased mortality included age greater than 80 years (OR 5.5, p = 0.003), need for preoperative mechanical ventilation (OR 3.1, p < 0.001), chronic steroid use (OR 2.9, p < 0.001), underlying cardiopulmonary disease (OR 2.0, p = 0.001), and acute renal failure (OR=1.7, p = 0.03). These and other comorbidities, including hepatic disease, a cancer diagnosis, and both insulin- and noninsulin-dependent diabetes mellitus, were used to construct a model to estimate the predicted probability of mortality, which ranged from 8.0{\%} to 96.1{\%} based on individual comorbidity profiles. These estimates differed substantially when compared with those obtained using the National Surgical Quality Improvement Program risk calculator, which estimated the risk of mortality among surgical patients as being consistently lower. Limitations: This study was limited by its retrospective design. Conclusions: Our surgical scoring system allows preoperative risk stratification for patients being evaluated for colectomy for C difficile infection, potentially helping to avoid futile surgery.",
author = "Kulaylat, {Audrey S.} and Zain Kassam and Hollenbeak, {Christopher S.} and David Stewart",
year = "2017",
month = "1",
day = "1",
doi = "10.1097/DCR.0000000000000920",
language = "English (US)",
volume = "60",
pages = "1285--1290",
journal = "Diseases of the Colon and Rectum",
issn = "0012-3706",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

A surgical Clostridium-associated risk of death score predicts mortality after colectomy for Clostridium difficile. / Kulaylat, Audrey S.; Kassam, Zain; Hollenbeak, Christopher S.; Stewart, David.

In: Diseases of the Colon and Rectum, Vol. 60, No. 12, 01.01.2017, p. 1285-1290.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A surgical Clostridium-associated risk of death score predicts mortality after colectomy for Clostridium difficile

AU - Kulaylat, Audrey S.

AU - Kassam, Zain

AU - Hollenbeak, Christopher S.

AU - Stewart, David

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: A Clostridium difficile-associated risk of death score was recently developed and validated by using a national cohort of both nonsurgical and surgical patients admitted with C difficile infection. However, risk scores specifically derived from surgical cohorts and designed for patients with C difficile infection are currently unavailable. Objective: The aim of this study was to develop a risk of death score for patients with C difficile infection who are being considered for total abdominal colectomy because of the failure of medical therapy. Design: This is a retrospective cohort study. Settings: This study was conducted with the use of a national database. Patients: All patients undergoing total colectomy for C difficile infection were identified in the National Surgical Quality Improvement Program database from 2005 to 2014. Main Outcome Measures: Variables similar to the original scoring system were used in multivariable analyses to determine the risk of 30-day mortality for patients, and a model was constructed to estimate the predicted probability of mortality after surgery. Results: Of 532 patients who underwent surgery, 32.7% experienced 30-day postoperative mortality. Patient covariates associated with significantly increased mortality included age greater than 80 years (OR 5.5, p = 0.003), need for preoperative mechanical ventilation (OR 3.1, p < 0.001), chronic steroid use (OR 2.9, p < 0.001), underlying cardiopulmonary disease (OR 2.0, p = 0.001), and acute renal failure (OR=1.7, p = 0.03). These and other comorbidities, including hepatic disease, a cancer diagnosis, and both insulin- and noninsulin-dependent diabetes mellitus, were used to construct a model to estimate the predicted probability of mortality, which ranged from 8.0% to 96.1% based on individual comorbidity profiles. These estimates differed substantially when compared with those obtained using the National Surgical Quality Improvement Program risk calculator, which estimated the risk of mortality among surgical patients as being consistently lower. Limitations: This study was limited by its retrospective design. Conclusions: Our surgical scoring system allows preoperative risk stratification for patients being evaluated for colectomy for C difficile infection, potentially helping to avoid futile surgery.

AB - Background: A Clostridium difficile-associated risk of death score was recently developed and validated by using a national cohort of both nonsurgical and surgical patients admitted with C difficile infection. However, risk scores specifically derived from surgical cohorts and designed for patients with C difficile infection are currently unavailable. Objective: The aim of this study was to develop a risk of death score for patients with C difficile infection who are being considered for total abdominal colectomy because of the failure of medical therapy. Design: This is a retrospective cohort study. Settings: This study was conducted with the use of a national database. Patients: All patients undergoing total colectomy for C difficile infection were identified in the National Surgical Quality Improvement Program database from 2005 to 2014. Main Outcome Measures: Variables similar to the original scoring system were used in multivariable analyses to determine the risk of 30-day mortality for patients, and a model was constructed to estimate the predicted probability of mortality after surgery. Results: Of 532 patients who underwent surgery, 32.7% experienced 30-day postoperative mortality. Patient covariates associated with significantly increased mortality included age greater than 80 years (OR 5.5, p = 0.003), need for preoperative mechanical ventilation (OR 3.1, p < 0.001), chronic steroid use (OR 2.9, p < 0.001), underlying cardiopulmonary disease (OR 2.0, p = 0.001), and acute renal failure (OR=1.7, p = 0.03). These and other comorbidities, including hepatic disease, a cancer diagnosis, and both insulin- and noninsulin-dependent diabetes mellitus, were used to construct a model to estimate the predicted probability of mortality, which ranged from 8.0% to 96.1% based on individual comorbidity profiles. These estimates differed substantially when compared with those obtained using the National Surgical Quality Improvement Program risk calculator, which estimated the risk of mortality among surgical patients as being consistently lower. Limitations: This study was limited by its retrospective design. Conclusions: Our surgical scoring system allows preoperative risk stratification for patients being evaluated for colectomy for C difficile infection, potentially helping to avoid futile surgery.

UR - http://www.scopus.com/inward/record.url?scp=85033566525&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85033566525&partnerID=8YFLogxK

U2 - 10.1097/DCR.0000000000000920

DO - 10.1097/DCR.0000000000000920

M3 - Article

C2 - 29112564

AN - SCOPUS:85033566525

VL - 60

SP - 1285

EP - 1290

JO - Diseases of the Colon and Rectum

JF - Diseases of the Colon and Rectum

SN - 0012-3706

IS - 12

ER -