Incidence, features, in-hospital outcomes and predictors of in-hospital mortality associated with toxic megacolon hospitalizations in the United States

Abstract

Toxic megacolon (TM) is a potentially fatal condition characterized by non-obstructive colonic dilatation and systemic toxicity. It is most commonly caused by inflammatory bowel disease (IBD). Limited data for TM are available demonstrating incidence, in-hospital outcomes and predictors of mortality. We sought to investigate incidence, characteristics, mortality and predictors of mortality associated with it. Data were obtained from the Healthcare Cost and Utilization Project (HCUP)'s Nationwide Inpatient Sample (NIS) database from January 2010 through December 2014. An analysis was performed on SAS 9.4 (SAS Institute Inc., Cary, NC). Patients below 18 years were excluded. A mixed-effects logistic regression model was developed to analyze predictors of mortality. Thus, 8139 (weighted) cases of TM were diagnosed between 2010 and 2014. TM is more prevalent in women (56.4%) than in men (43.6%), with a mean age of onset at 62.4 years, affecting whites (79.7%) more than non-whites. The most common reason for hospital admission included IBD (51.6%) followed by septicemia (10.2%) and intestinal infections (4.1%). Mean length of stay was 9.5 days and overall in-hospital mortality was 7.9%. Other complications included surgical resection of the large intestine (11.5%) and bowel obstruction (10.9%). Higher age, neurological disorder, coagulopathy, chronic pulmonary disease, heart failure, and renal failure were associated with greater risk of in-hospital mortality. TM is a serious condition with high in-hospital mortality. Management of TM requires an inter-disciplinary team approach with close monitoring. Patients with positive predictors in our study require special attention to prevent excessive in-hospital mortality.

<p>Toxic Megacolon: Background, Pathophysiology, Management Challenges and Solutions</p>

“…1,2 Despite its low prevalence, the outcomes are still unsatisfactory, with in-hospital mortality of 7.9%. 3,4 Our review aims are to highlight the crucial aspects and recent advancements regarding epidemiology, pathogenesis, and management of TM.…”

Megacolon following ileostomy reversal due to Clostridium difficile

“…The mechanism is again thought to be due to a change in the colonic microenvironment following diversion 4 . Megacolon in the setting of colitis regardless of the underlying aetiology carries a high mortality 6 . Here, we report a case of C. difficile megacolon post ileostomy reversal successfully treated with a combination of high‐dose oral vancomycin, intravenous metronidazole and colonic irrigation with vancomycin via colonoscopy.…”

Mortalidad en pacientes con falla intestinal en el Hospital Central del Estado, Chihuahua, México

“…Sin embargo, basta con hacer una revisión de la bibliografía en distintas fuentes de textos médicos para encontrar las cifras de mortalidad asociadas con cada patología condicionante específica, existen de igual manera muchos artículos que describen, según la experiencia personal de los autores, la asociación entre distintas patologías y su mortalidad como en la enfermedad de Crohn, siendo de 1.1 a 19.9%, la enfermedad inflamatoria intestinal 0.9%, el megacolon tóxico con resección intestinal y las fístulas intestinales 4% o la isquemia< mesentérica aguda 58%, entre otras. [15][16][17][18][19] Los pocos estudios específicos en FI describen una tasa de sobrevida de los pacientes en torno a 88-78% a los tres y cinco años, respectivamente. En otros centros se ha detectado una mortalidad de 16%.…”