title: Postoperative diarrhea and high ostomy output impact postoperative outcomes after elective colon and rectal operations regardless of Clostridium difficile infection.
abstract: BACKGROUND
  We aimed to review and compare outcomes of patients with and without Clostridium difficile infection (CDI) after elective colorectal operations.
  
  
  METHODS
  Retrospective 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).
  
  
  RESULTS
  Forty-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.
  
  
  CONCLUSIONS
  In 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.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 450, Minneapolis, MN 55455, USA.
authors.forename: Wolfgang B
authors.initials: WB
authors.lastname: Gaertner
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 450, Minneapolis, MN 55455, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Madoff
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 450, Minneapolis, MN 55455, USA.
authors.forename: Anders
authors.initials: A
authors.lastname: Mellgren
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 450, Minneapolis, MN 55455, USA.
authors.forename: Mary R
authors.initials: MR
authors.lastname: Kwaan
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 450, Minneapolis, MN 55455, USA. Electronic address: gmelton@umn.edu.
authors.forename: Genevieve B
authors.initials: GB
authors.lastname: Melton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000175:diagnosis / Q000453:epidemiology*; D003082:Colectomy; D003125:Colostomy; D003967:Diarrhea / Q000382:microbiology*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007081:Ileostomy; D007410:Intestinal Diseases / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology; D016896:Treatment Outcome
keywords: Clostridium difficile; Colorectal; Diarrhea; High stoma output; Postoperative