Patient selection: status post emergency colectomy for Clostridium difficile, with age >= 20 years
Outcome: 30-day mortality
Indications for emergency colectomy:
(1) failure of medical therapy
(2) toxic megacolon
(3) perforation and/or peritonitis
(4) fulminant disease with shock and multi-organ failure
Risk factors for mortality from a multivariate analysis:
(1) WBC count
(1a) >= 50,000 per microliter (leukocytosis; adjusted odds ratio 3.7)
(1b) 20,000 to 49,999 per µL (adjusted OR 0.63)
(2) preoperative serum lactate concentration
(2a) >= 5.0 mmol/L (adjusted OR 10.3)
(2b) 2.2 to 4.8 mmol/L (adjusted OR 2.7)
(3) older age (adjusted odds 1.03 per year), particularly age >= 75 years (baseline age taken as 20, the age of the youngest patient)
(4) serum albumin
(4a) < 15 g/L (adjusted OR 6.6)
(4b) 15.1 to 24.9 (adjusted OR 3.5)
Additional factors affecting mortality:
(1) infection with a hypervirulent strain of Cl. difficile
(2) delay in surgery
(3) renal failure (with elevated preoperative serum creatinine)
