title: Impact of Clostridium difficile colitis following closure of a diverting loop ileostomy: results of a matched cohort study.
abstract: OBJECTIVE
  Previous reports describing Clostridium difficile colitis (CDC) developing after the closure of a loop ileostomy suggest it is severe. In this study the incidence of CDC following ileostomy closure and its effect on the postoperative outcome have been studied.
  
  
  METHODS
  Patients undergoing closure of loop ileostomy from 2004 to 2008 were analysed using the Nationwide Inpatient Sample. Patients who developed postoperative CDC (n = 217) were matched 10:1 to a propensity-score-matched cohort of patients without CDC (n = 13 245). Linear and logistic regression were used to examine the effect of CDC on hospital cost (US dollars), length of stay and mortality rates. Population resampling was performed using nearest neighbour bootstrapping to confirm the validity of the results.
  
  
  RESULTS
  The incidence of CDC following ileostomy closure was 16 per 1000 patients. The mean length of stay was 11.5 days longer among CDC patients (P < 0.0001), with a greater cost of hospitalization of US$21 240 (P < 0.0001). There was no difference in mortality between the cohorts.
  
  
  CONCLUSIONS
  CDC following ileostomy closure is an uncommon, costly and morbid complication. Patients undergoing stoma closure are at high risk for an adverse outcome if they have CDC. Should it develop they should be aggressively treated.
authors: Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
authors: M Z
authors: MZ
authors: Wilson
authors: C S
authors: CS
authors: Hollenbeak
authors: D B
authors: DB
authors: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000191:economics / Q000209:etiology* / Q000401:mortality; D015331:Cohort Studies; D003092:Colitis / Q000191:economics / Q000209:etiology* / Q000401:mortality; D003365:Costs and Cost Analysis; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007081:Ileostomy; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000601:surgery; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000382:microbiology* / Q000401:mortality; D057216:Propensity Score
keywords: C. difficile; Ileostomy; colitis; post-operative