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Improved Outcome Following Colectomy for Fulminant Pseudomembranous Colitis (PMC)
Syed O. Ali, John P. Welch, Robert J. Dring
Hartford Hospital, Hartford, CT
Objective: To identify factors associated with improved survival following surgical intervention for PMC.
Design: Retrospective case series.
Setting: Tertiary care medical center.
Patients: 36 patients underwent colectomy for fulminant PMC: 17 from 1995-1999 (Group A) and 19 from 2000-2006 (Group B). Patients ( 21 females, 15 males) ranged from 40-89 years of age (mean 72 years). Co-morbidities included diabetes (38%), cardiovascular disease (77%), COPD (47%), and immunosuppressive medications (45%). 71% received antibiotics in the previous 2 months.
Presenting symptoms were diarrhea (67%), abdominal pain (89%), and fever (38%). All patients had positive stool assays for Clostridium difficile and/or pathologic diagnosis of PMC (pseudomembranes).
Interventions: All patients underwent colectomy.
Main Outcome Measures: Patients were stratified into groups based on: 1) two time periods and 2) survivorship data. Statistical analysis included Pearson's Chi-Square and Fisher's Exact Test.
Results: Survival increased from 35% (Group A, 6/17 patients) to 68% (Group B, 13/19 patients), p<0.05. Average time to operation was 2.5 days (Group A) vs. 1.4 days (Group B), n.s.; preoperative shock occurred in 70% (Group A) vs. 31% (Group B) , p<0.03. Survivorship was correlated with mean WBC (23,000 survivors vs. 40,000 non-survivors, p<0.01); multi-system organ failure (16% survivors vs. 47% non-survivors, p<0.05); and preoperative pressors (16% survivors vs. 47% non-survivors, p<0.05).
Conclusions: Survival following surgery for fulminant PMC improved over an 11-year period. Mortality was correlated with high WBC, preoperative pressor support, and multi-system organ failure. Despite higher co-morbidities, patients in Group B had less preoperative hemodynamic compromise.
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