Postoperative diarrhea and high ostomy output impact postoperative outcomes after elective colon and rectal operations regardless of Clostridium difficile infection

• Patients with postoperative diarrhea or high stoma output after elective colon and rectal operations regardless of Clostridium difficile status have significantly more superficial surgical site infections, longer hospital stays, and more readmissions compared with controls.
• Risk factors for postoperative C. difficile infection compared with controls without diarrhea or high stoma output included history of previous C. difficile infection, preoperative antibiotic treatment, chronic tobacco use, low serum albumin, chronic proton pump inhibitor use, mechanical bowel preparation, and ertapenem as preoperative antibiotic prophylaxis.
• Clostridium difficile infection after elective colon and rectal operations was uncommon and of low morbidity.

BackgroundWe aimed to review and compare outcomes of patients with and without Clostridium difficile infection (CDI) after elective colorectal operations.MethodsRetrospective cohort study of patients with CDI after elective colon and rectal operations from 2007 to 2012 (Group A) was conducted. Outcomes were compared with patients with a negative C. difficile toxin assay performed for postoperative diarrhea or high stoma output (Group B) and matched controls (Group C).ResultsForty-four patients (median age 53 years) developed CDI postoperatively (Group A). Fourteen patients (32%) had surgical site infections. Both Group A and Group B patients received ertapenem as preoperative antibiotic prophylaxis significantly more often than matched controls (P < .0001), and also had significantly more surgical site infections (P = .004), longer hospital stays (P = .003), and more readmissions (P = .02) compared with Group C patients.ConclusionsIn this study, postoperative CDI was uncommon, of low morbidity, and no mortality. Postoperative diarrhea and high stoma output, whether in patients who are C. difficile positive or not, appear to impact postoperative outcomes.