C. difficile risk increased in patients who undergo stoma reversal
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Patients who undergo elective stoma reversal are at higher risk for postoperative Clostridium difficile infection than patients undergo elective colectomy, according to new research published in Diseases of the Colon & Rectum.
Matthew Skancke, MD, of George Washington University Hospital, and colleagues wrote that they undertook the study to evaluate the varying risks for C. difficile infection (CDI) associated with restoration of intestinal continuity and colon resection.
“At our institution, we ... noticed that patients undergoing stoma reversal, in particular, had a higher incidence of postoperative Clostridium difficile infection compared to the average colectomy patient,” Skancke said in a video abstract. “This concerning observation prompted us to investigate whether stoma patients were of higher risk for postoperative Clostridium difficile as part of their clinical course.”
Skancke and colleagues reviewed data from the 2015 American College of Surgeons National Surgical Quality Improvement Project and targeted colectomy database to determine the impact of stoma reversal on postoperative CDI risk.
They compared incidence of CDI 30-days after surgery in 2,235 patients who underwent elective stoma reversal and 10,403 patients who underwent elective colectomy.
The investigators found that the incidence rate was significantly higher in the stoma reversal group compared with the colectomy group (3.04% vs. 1.25%; P < .001). After controlling for differences in the patient groups, they found that stoma reversal (OR = 2.701; 95% CI, 1.966–3.711; P < .001), as well as smoking, steroids and disseminated cancer all correlated with CDI in the 30-day period following surgery.
Because of the effects CDI can have, Skancke and colleagues said physicians need to keep these findings in mind when managing patients who undergo elective stoma reversal.
“We recommend that clinicians taking care of stoma reversal patients have a heightened sense of suspicion when confronted with a constellation of symptoms suggestive of postoperative Clostridium difficile,” Skancke said in the video. – by Alex Young
Disclosures : The authors report no relevant financial disclosures.