Effects of a New Hospital-Wide Surgical Consultation Protocol in Patients with Clostridium difficile Colitis

Gwendolyn M. Van Der Wilden, George C. Velmahos, Yuchiao Chang, Ed Bajwa, Walter J. O'Donnell, Kathleen Finn, N. Stuart Harris, D. Dante Yeh, David R. King, Marc A. De Moya, Peter J. Fagenholz

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

Background: Fulminant Clostridium difficile colitis (fCDC) occurs in 2%-8% of patients with CDC and carries a high death rate. Prompt operation may reduce death. Our aim was to determine whether a standardized hospital-wide protocol for surgical referral in CDC would result in earlier surgical consultation, earlier identification of patients who could benefit from surgical therapy, and reduced deaths from fCDC. Methods: A multidisciplinary team developed consensus criteria for surgical consultation. Compliance was evaluated by prospective review of all inpatient CDC cases. Outcomes of the prospective cohort (POST) were compared to an historic control group (PRE). Results: From November 1, 2010 to October 31, 2012, we identified 1,106 inpatients with CDC; 339 patients matched the consultation criteria, of whom 213 received a surgical consultation, resulting in an overall compliance rate of 62.8%. All those with fCDC received a surgical consultation, with a median time to surgical referral of three hours. Of 46 patients with fCDC, 11 (23.9%) died, compared with 34.8% in the historical control group (p = 0.15). The death rate was 14.7% in the POST group, when excluding patients with limitations of care and those transferred to our institution in a fulminant state. There was a shorter interval between admission and surgical intervention for those who required operation in the POST group-three (1-11) days versus 1.5 (0-3) days, respectively, in the PRE and POST groups (p = 0.018), and a shorter adjusted median hospital length of stay (adjusted difference 9.0, 95% CI 2.2-12.3, p = 0.007) Conclusions: A hospital-wide protocol with established criteria for surgical consultation resulted in faster intervention and a shorter adjusted median hospital length of stay. The overall death rate for fCDC patients without limitations of life-sustaining treatment who presented to our emergency department or in whom fCDC developed while they were admitted to our hospital was 14.7%.

Original languageEnglish (US)
Pages (from-to)563-569
Number of pages7
JournalSurgical infections
Volume18
Issue number5
DOIs
StatePublished - Jul 2017
Externally publishedYes

Keywords

  • consultation criteria;

ASJC Scopus subject areas

  • Surgery
  • Microbiology (medical)
  • Infectious Diseases

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