Is colectomy for fulminant Clostridium difficile colitis life saving? A systematic review
Article first published online: 30 JUL 2013
Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland
Volume 15, Issue 7, pages 798–804, July 2013
How to Cite
Stewart, D. B., Hollenbeak, C. S. and Wilson, M. Z. (2013), Is colectomy for fulminant Clostridium difficile colitis life saving? A systematic review. Colorectal Disease, 15: 798–804. doi: 10.1111/codi.12134
- Issue published online: 30 JUL 2013
- Article first published online: 30 JUL 2013
- Accepted manuscript online: 25 JAN 2013 09:46AM EST
- Manuscript Accepted: 15 NOV 2012
- Manuscript Received: 5 SEP 2012
- Clostridium difficile ;
It is unclear whether colectomy for fulminant Clostridium difficile colitis (FCDC) leads to a improvement in survival compared with continued medical therapy for this moribund population.
Selected studies from 1994–2010 were identified through a comprehensive search theme applied to MEDLINE (OvidSP and PubMed), EMBASE and by hand searching. Data regarding mortality rates between medically and surgically treated patients were extracted. Risk of bias was assessed using a Newcastle–Ottawa Scale score. A meta-analysis of the odds ratios for mortality between surgical and medical treatment for FCDC was conducted using the Mantel–Haenszel method and fixed-effects modelling.
Five hundred and ten patients with FCDC were identified in six studies. The pooled adjusted odds ratio of mortality comparing surgery with medical therapy was 0.70 (0.49–0.99), suggesting that surgery provided a survival benefit.
Emergent colectomy for patients with FCDC provides a survival advantage compared with continuing antibiotics. Though there is selection bias of patients having surgery, the results of this systematic review suggest that colectomy has a therapeutic role in treating severe forms of C. difficile colitis.