No survival advantage exists for patients undergoing loop ileostomy for clostridium difficile colitis

Hall, Brendan; Leinicke, Jennifer A.; Armijo, Priscila Rodrigues; Smith, Lynette M.; Langenfeld, Sean J.; Oleynikov, Dmitry

doi:10.1016/j.amjsurg.2018.09.023

Cited by 28 publications

(19 citation statements)

References 16 publications

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“…Looking beyond mortality, Hall et al reported a decreased need for transfusion, 14 which was corroborated by the multi-institutional study by Ferrada et al 17 Not all findings have proved favorable for DLI. Our review revealed notable differences in certain postoperative complications.…”

Section: Discussionmentioning

confidence: 85%

“…Where specified, DLI was performed laparoscopically 73% of the time (range 64-83%). 9,14,16 Patients undergoing DLI tended to be younger; however, this was only reported as significant in one study. 15 No differences were reported by gender.…”

Section: Resultsmentioning

confidence: 90%

“…The original study by Neal et al 9 offered the only prospective data for DLI, but used historically matched retrospective data for their TAC group. The 2 largest and most recent studies used national administrative databases, 14,15 while the rest were either single or multi-institutional cohort studies. All studies were comparative, comparing outcomes between DLI and TAC.…”

Section: Resultsmentioning

confidence: 99%

“…9,17 The 2 studies that reported differences in preoperative conditions (Hall et al and Juo et al) also found no associated differences in mortality between their 2 groups. 14,15 Another potential confounding factor could be differences in timing of surgery. It has been proposed that surgeons may be more likely to perform DLI earlier in the hospital course thus favoring outcomes for DLI.…”

Section: Discussionmentioning

confidence: 99%

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Diverting Loop Ileostomy for Clostridium Difficile Colitis: A Systematic Review and Meta-analysis

Shellito

Russell

2020

The American Surgeon

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Diverting loop ileostomy (DLI) with colonic lavage has been proposed as an alternative to total abdominal colectomy (TAC) for fulminant Clostridium difficile infection (CDI). Controversy exists regarding the mortality benefit and outcomes of this surgical approach. We conducted a MEDLINE database search for articles between 1999 and 2019 pertaining to DLI for the surgical treatment of CDI. Five articles met the inclusion criteria. Four studies were retrospective and one was a prospective matched cohort study. 3683 patients were included in the 5 studies; 733 patients (20%) underwent DLI, while 2950 patients (80%) underwent TAC. The only shared outcome measure across all 5 studies was mortality. The overall mortality rate for the entire cohort undergoing both procedures was 30.3%. There was no statistically significant difference in pooled mortality between DLI and TAC (OR: .73; 95% CI, .45-1.2; P = .22). Reporting of other postoperative outcomes was variable. Fulminant CDI remains a life-threatening condition with high mortality. Loop ileostomy may be a viable surgical alternative to total colectomy with similar mortality; however, further work is needed to determine specific patient characteristics that warrant routine use of DLI.

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Section: Discussionmentioning

confidence: 85%

Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Diverting Loop Ileostomy for Clostridium Difficile Colitis: A Systematic Review and Meta-analysis

Shellito

Russell

2020

The American Surgeon

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“…81,82 However, recent data from over 400 patients in a surgical database found no difference in mortality between loop ileostomy and total colectomy, though there was benefit in terms of colon preservation. 83 Despite the lack of high-quality evidence, it is prudent to say that early surgical consultation and careful monitoring of a patient’s clinical condition are vital. The choice of surgical procedure remains controversial, though loop ileostomy is clearly beneficial in colon preservation.…”

Section: Treating Severe and Severe-complicated (Fulminant) Diseasementioning

confidence: 99%

Management ofClostridioides difficilecolitis: insights for the gastroenterologist

Saha

Khanna

2019

Therap Adv Gastroenterol

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Clostridioides difficile infection (CDI) is a common cause of diarrhea in both inpatient and outpatient settings. The last few years have seen major changes in the treatment spectrum of CDI, most notably, recommendations against using metronidazole for initial CDI, the addition of fidaxomicin and bezlotoxumab, and emergence of microbial replacement therapies. Several other therapies are undergoing clinical trials. This narrative review focuses on the treatment of CDI with a summary of literature on the newer modalities and the treatment guidelines issued by Infectious Diseases Society of America and European Society of Clinical Microbiology and Infectious Diseases.

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Trends in Diverting Loop Ileostomy vs Total Abdominal Colectomy as Surgical Management forClostridium difficileColitis

et al. 2019

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IMPORTANCE Diverting loop ileostomy and colonic lavage has generated much interest since it was first reported as a potential alternative to total abdominal colectomy for treating Clostridium difficile colitis in 2011. To our knowledge, few studies have validated the benefit reported in the initial description, and the association of this new approach with practice patterns has not been described. OBJECTIVE To examine the national adoption pattern and outcomes of diverting loop ileostomy vs total abdominal colectomy as treatment for fulminant C difficile colitis. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from hospitals participating in the National Inpatient Sample database across the United States from January 2011 to September 2015 and included 3021 adult patients who underwent surgery for C difficile colitis during the study period, comprising 2408 subtotal colectomies and 613 loop ileostomies. The data were analyzed between November 2018 and April 2019. EXPOSURES Loop ileostomy as surgery of choice. MAIN OUTCOMES AND MEASURES In-hospital mortality. RESULTS Of 2408 participants, 1416 (58.8%) were women, 1781 (78.4%) were white, and 627 (21.6%) were individuals of color and the mean (SD) age was 68.2 (14.8) years. During the overall study period, 613 patients (20.28%) underwent diverting loop ileostomy without total abdominal colectomy. The annual proportion of patients undergoing only diversion increased from 11.16% in 2011 to 25.30% in 2015. Significantly more loop ileostomies were performed within the first day of hospitalization, in contrast to subtotal colectomies (23.31% vs 12.21%; P < .01). There was no significant difference in in-hospital mortality rates between the 2 groups (25.98% vs 31.18%; P = .28). CONCLUSIONS AND RELEVANCE This study demonstrates the adoption of diverting loop ileostomy to treat C difficile colitis across the United States. While fulminant C difficile colitis remains a condition with high mortality rates, no significant difference in this outcome was observed between loop ileostomy and total abdominal colectomy. Loop ileostomy may represent a viable surgical alternative to total abdominal colectomy, although the grounds for selection of treatment need to be clarified.

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No survival advantage exists for patients undergoing loop ileostomy for clostridium difficile colitis

Cited by 28 publications

References 16 publications

Diverting Loop Ileostomy for Clostridium Difficile Colitis: A Systematic Review and Meta-analysis

Diverting Loop Ileostomy for Clostridium Difficile Colitis: A Systematic Review and Meta-analysis

Management ofClostridioides difficilecolitis: insights for the gastroenterologist

Trends in Diverting Loop Ileostomy vs Total Abdominal Colectomy as Surgical Management forClostridium difficileColitis

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