Clostridium difficile Infection After Colorectal Surgery: A Rare but Costly Complication

Damle, Rachelle N.; Cherng, Nicole; Flahive, Julie; Davids, Jennifer S.; Maykel, Justin A.; Sturrock, Paul R.; Sweeney, W. Brian; Alavi, Karim

doi:10.1007/s11605-014-2600-7

Cited by 32 publications

(18 citation statements)

References 25 publications

(27 reference statements)

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“…Patients undergoing colectomy are at a unique risk of Clostridium difficile because of the additional physical disruption of the colonic microflora. The impact of postoperative Clostridium difficile infection is being increasingly reported with overall worse outcome after colon resection [109] . It was reported that postoperative diarrhea or high stoma output regard less of Clostridium difficile infection could increase significantly more superficial surgical site infections including AL [110] , which may indicate the interaction between AL and the intraluminal pressure increased by postoperative diarrhea.…”

Section: Intestinal Microbesmentioning

confidence: 99%

Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis

Kawada

Sakai

2016

WJG

104

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Anastomotic leakage (AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection (LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR.

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Section: Intestinal Microbesmentioning

confidence: 99%

Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis

Kawada

Sakai

2016

WJG

104

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“…This finding is in contrast with recent literature suggesting that IBD is a risk factor for CDi in the colorectal surgery population. 18 however, corticosteroid use was associated with 50% higher odds of CDi, which may have been a confounder for IBD in previous work in which corticosteroid use was not included as a risk factor in the analysis. furthermore, the current study further confirms that major teaching hospitals and hospitals in urban settings have higher rates of hospital-acquired CDi.…”

Section: Discussionmentioning

confidence: 70%

“…in the surgical population, hospital-acquired CDi is associated with higher rates of complications, intensive care unit admission, 30-day readmission, 30-day mortality, longer length of stay, and up to $14,000 higher costs for the index hospital stay. 6,18,19,21 Because of the high morbidity, mortality, and healthcare use associated with CDi, the association for Professionals in infection Control and epidemiology has published extensive evidence-based guidelines for preventing CDi. 22 the 4 key areas for prevention include hand hygiene, contact/isolation precautions, environmental infection prevention, and antimicrobial stewardship.…”

Section: Discussionmentioning

confidence: 99%

High Variability in Nosocomial Clostridium difficile Infection Rates Across Hospitals After Colorectal Resection

Aquina

Probst

Becerra

et al. 2016

Diseases of the Colon &Amp; Rectum

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Colorectal surgery patients appear to be at high risk for C. difficile infection, and alarming variation in nosocomial C. difficile infection rates currently exists among hospitals after colorectal resection. Given the high morbidity and cost associated with C. difficile colitis, adopting institutional quality improvement programs and maintaining strict prevention strategies are of the utmost importance.

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“…Post-operative complications in colorectal cancer may result in functional impairments or even fatal outcomes for the patient, and also lead to an increase in medical costs associated with an extension of the hospital stay ( 11 – 13 ). Predicting the development of post-operative complications is useful in the perioperative management of patients, beginning pre-operatively and continuing into the post-operative period, and an early response to post-operative complications has contributed to a decrease in post-operative mortality rates ( 14 , 15 ).…”

Section: Discussionmentioning

confidence: 99%

Pre-operative granulocyte/lymphocyte ratio as a predictive marker of post-operative complications in patients with colorectal cancer

Shimazaki¹,

Nakachi²,

Motohashi³

et al. 2014

Oncology Letters

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The aim of the present study was to assess the clinical relevance of the pre-operative granulocyte/lymphocyte (G/L) ratio as a predictive marker of post-operative complications in patients with colorectal cancer. In total, 85 patients (59 males and 26 females; mean age, 68.9 years) underwent surgery for colorectal cancer at the Department of Surgery, Ibraki Medical Center, Tokyo Medical University (Ami, Japan), and were divided into post-operative complication and non-complication groups. Clinical data, including age, gender, body mass index, tumor localization, tumor pathological type, cancer staging, surgery time, volume of surgical bleeding, pre-operative G/L ratio and further pre-operative laboratory data, including levels of albumin and C-reactive protein, Glasgow Prognostic Score, white blood cell count and levels of hemoglobin, creatine kinase, lactate dehydrogenase, carcinoembryonic antigen and carbohydrate antigen 19-9 were analyzed between these groups. The total post-operative complication rate was 18.8%. On univariate analysis, the amount of surgical bleeding and the pre-operative G/L ratio were significantly higher in the complication group than in the non-complication group (299.8±361.7 vs. 155.6±268.6 ml, P<0.05; and 6.73±10.38 vs. 3.49±2.78, P<0.05, respectively). Multivariate logistic regression analysis for the risk factors of post-operative complications, determined using univariate analysis, demonstrated that the amount of surgical bleeding and the pre-operative G/L ratio were independent risk factors of post-operative complications in patients with colorectal cancer. In conclusion, the G/L ratio may be a clinically relevant pre-operative predictive marker for post-operative complications.

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Clostridium difficile Infection After Colorectal Surgery: A Rare but Costly Complication

Cited by 32 publications

References 25 publications

Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis

Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis

High Variability in Nosocomial Clostridium difficile Infection Rates Across Hospitals After Colorectal Resection

Pre-operative granulocyte/lymphocyte ratio as a predictive marker of post-operative complications in patients with colorectal cancer

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