Influence of prior appendectomy and cholecystectomy on Clostridioides difficile infection recurrence and mortality - 26/10/19

Doi : 10.1016/j.amjsurg.2019.10.038

Jan Franko ^a,^⁎ , Benjamin Ferrel ^a, Paul Pierson ^a, Shankar Raman ^a, Daniela Frankova ^b, Lindsey M. Rearigh ^b, Aneesa Afroze ^b, Maria A. Guevara Hernandez ^b, David Terrero-Salcedo ^b, David Kermode ^a, Marc Gorvet ^a
^a Department of Surgery. MercyOne Medical Center, Des Moines, IA, USA
^b Department of Internal Medicine. MercyOne Medical Center, Des Moines, IA, USA

^∗Corresponding author. 411 Laurel St, Ste 2100 Des Moines, IA, 50314, USA.411 Laurel StSte 2100 Des MoinesIA50314USA

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 26 October 2019

Abstract

Background

Remote appendectomy was linked to increased incidence of Clostridioides difficile infection (CDI). We evaluated the effect of absence of vermiform appendix and/or gallbladder on recurrence rate and severity of CDI.

Methods

We assessed a systemwide patient cohort diagnosed with initial CDI in 2014 (n = 250). The primary outcome was recurrence.

Results

Appendix and gallbladder were absent among 47 and 64 patients, respectively. CDI recurrence rate was similar among patients without and with appendix (24/47, 51.1% versus 90/203 patients, 44.3%; p = 0.404) and similar among patients without and with gallbladder (29/64 patients, 45.3% versus 85/186 patients, 45.7%; p = 0.957). Mortality was similar between appendectomy versus appendix in situ patients (3/47, 6.4% versus 9/203, 4.4%; p = 0.573), but higher mortality rate was seen among those without gallbladder (7/64 patients with prior cholecystectomy, 10.9% versus 5/186 patients with intact gallbladder, 2.7%; p = 0.008).

Conclusion

Clostridioides difficile recurrence rate is not affected by remote appendectomy or cholecystectomy. Patients with prior cholecystectomy experience higher mortality rates associated with their CDI.

Le texte complet de cet article est disponible en PDF.

Highlights

•	No difference in Clostridioides difficile recurrence whether appendix is present or absent.
•	Mortality of Clostridioides difficile infection is not altered by appendectomy.
•	No difference in Clostridioides difficile recurrence whether gallbladder is present or absent.
•	Increased Clostridioides difficile infection-related mortality among patients missing their gallbladder.