Elective Stoma Reversal Has a Higher Incidence of Postoperative Clostridium Difficile Infection Compared With Elective Colectomy: An Analysis Using the American College of Surgeons National Surgical Quality Improvement Program and Targeted Colectomy Databases

Abstract

Patients who undergo elective stoma reversal have a higher incidence of postoperative C difficile infection compared with patients who undergo an elective colectomy. Given the impact of postoperative C difficile infection, a heightened sense of suspicion should be given to symptomatic patients after stoma reversal. See at Video Abstract at http://links.lww.com/DCR/A553.

2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

“…Recently, a retrospective colectomy database review of the 2015 American College of Surgeons National Surgical Quality Improvement Project [102] demonstrated that stoma reversal (OR = 2.701, 95% CI 1.966–3.711; p < 0.001), smoking (OR = 1.520, 95% CI 1.063–2.174; p = 0.022), steroids (OR = 1.677, 95% CI 1.005–2.779; p = 0.048), and disseminated cancer (OR = 2.312, 95% CI 1.437–3.719; p = 0.001) were associated with CDI in the 30-day postoperative period.…”

Clostridium difficile infection following reversal of loop ileostomy: an uncommon but significant complication

“…There are few cohort and case studies describing CDI following loop ileostomy reversal. Previous studies have reported incidence of up to 4%, 3,4 but a systematic review in 2017 found it to be less common at 1.8% 5 …”

Clostridioides difficile infection following ileostomy reversal – can we clean up our act?

“…For instance, the largest study of 2235 patients by Skancke et al observed a 3.04% incidence of CDI after ileostomy reversal versus 1.25% for elective colonic resection. 2 Similarly, Randall et al reported that the CDI rate was higher following ileostomy reversal (4.2%) compared with right hemicolectomy (2.1%) and anterior resection (1%). 4 Proposed mechanisms for this discrepancy in incidence of CDI following reversal of ileostomy compared with colonic resection include changes in the colonic microbiome due to diversion of faecal stream 7 as well as ileal CD colonization.…”