Behind The Knife: The Surgery Podcast7 Aug 2023

Journal Review in Emergency General Surgery: Clostridium Difficile Infection

An ever-present spectre looming over the hearts of general surgeons everywhere! Please join our Emergency General Surgery team for a journal review about Clostridium difficile (C. diff) infection. Dr. Ashlie Nadler and Dr. Jordan Nantais are joined by guest Dr. Marika Sevigny, recent graduate of trauma and acute care surgery at the University of Toronto, as Dr. Graham Skelhorne-Gross prepares for his upcoming fellowship at Harborview.

Paper 1: Ahmed et al. Risk factors of surgical mortality in patients with Clostridium difficile colitis. A novel scoring system. Eur J Trauma Emerg Surg. 2022 Jun.
- Risk score development study using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP)
- 525 adult (18-89) patients undergoing colectomy between 2012 and 2016
- Split data into training (80%) and testing (20%) datasets
- Identified mortality risk factors to create and validate a scoring system
- Scores ranged from 0 to 37 with the highest score predicting an 83.9% risk of mortality
- This scoring system appears relatively straight-forward and methodically sound but the lack of a currently available calculator limits use to some degree

Paper 2: McKechnie et al. Total Abdominal Colectomy Versus Diverting Loop Ileostomy and Antegrade Colonic Lavage for Fulminant Clostridioides Colitis: Analysis of the National Inpatient Sample 2016-2019. J Gastrointest Surg. 2023 Apr 20.
- Retrospective cohort study of adults (18+) in the National Inpatient Sample (NIS) admitted between Jan 2016 and Dec 2019 for C. difficile colitis, undergoing either a total abdominal colectomy (TAC) or diverting loop ileostomy (DLI) with antegrade vancomycin enemas
- Focus on not only mortality and complications but also admission cost and length of stay
- 886 TAC and 409 DLI patients were identified
- Multivariable logistic regression analysis showed no difference in mortality or overall complications
- TAC patients had shorter admissions (mean difference 4.06 days) and lower cost (mean difference $79,715.34)
- Study was limited as it considered only the initial admission and is unable to provide data on outcomes and costs beyond this time
- Furthermore, there is consideration for disease severity in the analysis, which may impede the ability to compare the two operative approaches

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