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Is colectomy for fulminant Clostridium difficile colitis life saving? A systematic review
Author(s) -
Stewart D. B.,
Hollenbeak C. S.,
Wilson M. Z.
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.12134
Subject(s) - medicine , colectomy , fulminant , clostridium difficile , clostridium difficile colitis , odds ratio , medline , population , mortality rate , intensive care medicine , surgery , ulcerative colitis , antibiotics , disease , environmental health , law , microbiology and biotechnology , political science , biology
Aim It is unclear whether colectomy for fulminant Clostridium difficile colitis (FCDC) leads to a improvement in survival compared with continued medical therapy for this moribund population. Method Selected studies from 1994–2010 were identified through a comprehensive search theme applied to MEDLINE (OvidSP and PubMed), EMBASE and by hand searching. Data regarding mortality rates between medically and surgically treated patients were extracted. Risk of bias was assessed using a Newcastle–Ottawa Scale score. A meta‐analysis of the odds ratios for mortality between surgical and medical treatment for FCDC was conducted using the Mantel–Haenszel method and fixed‐effects modelling. Results Five hundred and ten patients with FCDC were identified in six studies. The pooled adjusted odds ratio of mortality comparing surgery with medical therapy was 0.70 (0.49–0.99), suggesting that surgery provided a survival benefit. Conclusion Emergent colectomy for patients with FCDC provides a survival advantage compared with continuing antibiotics. Though there is selection bias of patients having surgery, the results of this systematic review suggest that colectomy has a therapeutic role in treating severe forms of C. difficile colitis.