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Impact of C lostridium difficile colitis following closure of a diverting loop ileostomy: results of a matched cohort study
Author(s) -
Wilson M. Z.,
Hollenbeak C. S.,
Stewart D. B.
Publication year - 2013
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12128
Subject(s) - medicine , ileostomy , propensity score matching , incidence (geometry) , cohort , logistic regression , clostridium difficile , surgery , physics , optics , microbiology and biotechnology , biology , antibiotics
Aim Previous reports describing C lostridium difficile colitis ( CDC ) developing after the closure of a loop ileostomy suggest it is severe. In this study the incidence of CDC following ileostomy closure and its effect on the postoperative outcome have been studied. Method Patients undergoing closure of loop ileostomy from 2004 to 2008 were analysed using the Nationwide Inpatient Sample. Patients who developed postoperative CDC ( n = 217) were matched 10:1 to a propensity‐score‐matched cohort of patients without CDC ( n = 13 245). Linear and logistic regression were used to examine the effect of CDC on hospital cost ( US dollars), length of stay and mortality rates. Population resampling was performed using nearest neighbour bootstrapping to confirm the validity of the results. Results The incidence of CDC following ileostomy closure was 16 per 1000 patients. The mean length of stay was 11.5 days longer among CDC patients ( P < 0.0001), with a greater cost of hospitalization of US $21 240 ( P < 0.0001). There was no difference in mortality between the cohorts. Conclusion CDC following ileostomy closure is an uncommon, costly and morbid complication. Patients undergoing stoma closure are at high risk for an adverse outcome if they have CDC . Should it develop they should be aggressively treated.