Minimally invasive approach in appendectomy and cholecystectomy reduces risk for early but not late-onset Clostridioides difficile infection
Hugo Bonatti1, Tjasa Hranjec2, Robert G Sawyer3, Karim W Sadik4
1 Department of Surgery, University of Virginia Health Systems, Charlottesville, VA; Meritus Health, Meritus Surgical Specialists, Hagerstown, MD, USA
2 Department of Surgery, University of Virginia Health Systems, Charlottesville, VA; Division of Transplantation, Department of Surgery, Milton S. Hershey Medical Center, Hershey PA, USA
3 Department of Surgery, University of Virginia Health Systems, Charlottesville, VA; Department of Surgery, Western Michigan University School of Medicine, Kalamazoo, MI, USA
4 Department of Surgery, Division of Reconstructive Surgery, Guthrie Clinic, Sayre, PA, USA
Meritus Health, Meritus Surgical Specialists, Hagerstown, MD 21742
Source of Support: None, Conflict of Interest: None
Introduction: Clostridioides difficile-associated colitis (CDAC) may develop even after minor abdominal surgeries such as appendectomy and cholecystectomy. Minimally invasive techniques may reduce rates of postoperative CDAC due to less surgical trauma, shorter hospitalizations, and a lower incidence of certain complications.
Patients and Methods: This retrospective cohort study includes a total of 10,601 patients undergoing appendectomy (2529 laparoscopic and 2049 open) and cholecystectomy (3541 laparoscopic and 2482 open) at a single center between 1992 and 2011, who were diagnosed with CDAC and were followed for a minimum of 2 years.
Results: Cumulative CDAC rates were 2.3% after appendectomy and 4% after cholecystectomy (P < 0.0001) with 2.1% for all laparoscopic and 4.8% for all open procedures (P < 0.0001). The median time to CDAC onset was 76d after appendectomy and 122d after cholecystectomy (P < 0.05). Factors associated with the development of CDAC were older age (median 52 vs. 38 years, P < 0.0001), length of stay (median 8 vs. 2 days, P < 0.0001), development of non-C. difficile infections (23% vs. 7%, P < 0.0001), and having an open procedure (4.8% vs. 2.1%, P < 0.0001). Almost 40% of all patients developed their CDAC after 1 year and age, length of stay, and development of non-C. difficile infections or open surgical approach were not found to be risk factors.
Conclusion: Patients undergoing open appendectomy and cholecystectomy have a higher risk for early-onset CDAC when compared to their laparoscopic counterparts. Late-onset CDAC after these procedures is common and seems unrelated to perioperative factors.