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Diverting loop ileostomy versus total abdominal colectomy for clostridioides difficile colitis: outcomes beyond the index admission

  • 2020 SAGES Oral
  • Published:
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Abstract

Introduction

Diverting loop ileostomy (DLI) and colonic lavage has emerged as a valid alternative to total abdominal colectomy (TAC) for the surgical management of Clostridioides difficile colitis (CDC). However, little data are available on outcomes beyond the index admission. The objective of this study was to compare post-discharge outcomes between patients who underwent DLI and TAC for CDC.

Methods

Adult patients who underwent DLI or TAC for CDC between 2011 and 2016 were identified from the Nationwide Readmissions Database, and only discharges between January and September in each calendar year were included to allow for a 90-day follow-up period for all cases. Ninety-day overall in-hospital mortality (index admission mortality plus 90-day post-discharge mortality) and 90-day unplanned readmissions were compared. To assess 6-month ileostomy reversal rates, the cohort was then truncated to exclude discharges after June in each calendar year. Multivariate regression was used to adjust for patient demographics and disease severity.

Results

In total, 2070 patients were discharged between January and September of each included year: 1486 (71.8%) TAC compared to 584 (28.2%) DLI. Overall in-hospital mortality was higher among patients who underwent TAC (34.5% vs. 27.7%, p = 0.004); however, this association did not remain on multivariate regression (OR 1.14, 95% CI 0.91–1.43). Among the 1434 patients who were discharged alive, the 90-day unplanned readmission rate was similar in both groups (TAC: 26.1% vs. DLI: 23.1%, p = 0.26). After truncating the cohort to those patients discharged alive between January and June of each included year (n = 1016), patients who underwent DLI had a significantly greater 6-month ileostomy reversal rate (26.4% vs. 8.3%, p < 0.001). DLI was independently associated with higher odds of 6-month ileostomy reversal (OR 2.68, 95% CI 1.80–4.00).

Conclusions

In the surgical management of CDC, DLI is associated with equivalent mortality and unplanned readmission, but greater likelihood of 6-month ileostomy reversal, compared to TAC.

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Author notes

  1. Maria Abou-Khalil and Richard Garfinkle have co-primary authorship.

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada

    Maria Abou-Khalil, Richard Garfinkle, Mohammed Alqahtani, Nancy Morin, Carol-Ann Vasilevsky & Marylise Boutros

  2. Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, G-317, Montreal, QC, H3T 1E2, Canada

    Marylise Boutros

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  1. Maria Abou-Khalil
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  2. Richard Garfinkle
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Correspondence to Marylise Boutros.

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Maria Abou-Khalil, Richard Garfinkle, Mohammed Alqahtani, Nancy Morin, Carol-Ann Vasilevsky, Marylise Boutros have no conflicts of interest or financial ties to disclose.

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Abou-Khalil, M., Garfinkle, R., Alqahtani, M. et al. Diverting loop ileostomy versus total abdominal colectomy for clostridioides difficile colitis: outcomes beyond the index admission. Surg Endosc 35, 3147–3153 (2021). https://doi.org/10.1007/s00464-020-07755-6

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