Prolonged non-operative management of clostridium difficile colitis is associated with increased mortality, complications, and cost

Background: We aim to investigate the effects of delaying surgery on outcomes and cost in patients admitted with severe clostridium difficile infection (CDI). Methods: The Vizient database was queried for patients with CDI who underwent open total abdominal colectomy (TAC). Patients operated on the day of admission were excluded. Chi-square, Fisher's exact, student T-test, and logistic regression were performed with alpha = 0.05. Results: Logistic regression analyses using days from admission to surgery (DATO), age, race, and gender demonstrated that increased DATO was associated with higher 30-day mortality (OR 1.022, 95% CI 1.001-1.044, p = 0.040), overall complications (OR 1.034, 95% CI 1.014-1.054, p = 0.001), and infectious complications (OR 1.040, 95% CI 1.018-1.062, p < 0.001) compared to age for all three outcomes. Total length of stay (LOS), intensive care unit LOS, and direct cost increased in conjunction with DATO (p < 0.001). Conclusions: Early surgical intervention in appropriately selected patients should be considered when there is a high suspicion for prolonged non-operative treatment. (C) 2019 Elsevier Inc. All rights reserved.