Incidence of Early and Late-Onset Clostridioides difficile Infection following Appendectomy Compared to Other Common Abdominal Surgical Procedures

K W Sadik; T Hranjec; H J R Bonatti; R G Sawyer

doi:10.1155/2022/8720144

Incidence of Early and Late-Onset Clostridioides difficile Infection following Appendectomy Compared to Other Common Abdominal Surgical Procedures

Surg Res Pract. 2022 Jun 7:2022:8720144. doi: 10.1155/2022/8720144. eCollection 2022.

Authors

K W Sadik¹, T Hranjec^{2

3}, H J R Bonatti^{2

4}, R G Sawyer^{2

5}

Affiliations

¹ Department of Surgery, Div. of Reconstructive Surgery, Guthrie Clinic, Sayre, PA, USA.
² Department of Surgery, University of Virginia Health Systems, Charlottesville, VA, USA.
³ Division of Transplantation, Department of Surgery, Milton S, Hershey Medical Center, Hershey, PA, USA.
⁴ Meritus Surgical Specialists, Hagerstown, MD, USA.
⁵ Western Michigan University School of Medicine, Kalamazoo, MI, USA.

Abstract

Introduction: Clostridioides difficile associated diarrhea (CDAD) is a major public health issue. The appendix may function as a reservoir for the intestinal microbiome, which may repopulate the intestine following enteric infections including CDAD. Patients/Methods. This retrospective cohort study includes a total of 12,039 patients undergoing appendectomy, hemicolectomy, and cholecystectomy at a single center between 1992 and 2011 who were diagnosed with early and late-onset CDAD and were followed for a minimum of two years.

Results: Cumulative CDAD rates were 2.3% after appendectomy, 6.4% after left and 6.8% after right hemicolectomy, and 4% after cholecystectomy with a median onset of 76 (range 1-6011) days after the procedure. Median time to CDAD onset was 76 days after appendectomy, 23 days after left, 54 days after right hemicolectomy, and 122 days after cholecystectomy (p < 0.05). Late-onset CDAD (>1 year) was significantly more common following appendectomy (37%) and cholecystectomy (39%) than after left (17%) and right (21%) hemicolectomy. Significant differences in age, gender, complication rate, and length of hospitalization between the four groups need to be considered when interpreting the results.

Conclusion: The incidence of CDAD after various abdominal surgeries ranged between 2% and 7% in this study. Whereas, hemicolectomy patients had predominantly early onset CDAD, and appendectomy and cholecystectomy may increase the risk for late-onset CDAD. Appendectomy per se does not seem to increase the risk for late-onset CDAD.