A diverting ileostomy is typically performed to divert intestinal contents in high-risk colorectal anastomoses. Ileostomy closure is associated with high rates of post-operative Clostridium difficile infection (CDI). Risk factors for the development of Clostridium difficile infection are unclear, however, a correlation has been observed with delayed closure.
However, a delay to reversal of ileostomy of >365 days was associated with a higher incidence of Clostridium difficile infection post-operatively, a recent study reports as published in the Journal of Colorectal Disease.
Simon J G Richards and colleagues from the Colorectal Surgical Unit, Department of General Surgical Specialties, Royal Melbourne Hospital. Melbourne, Australia aimed to assess the odds of developing Clostridium difficile infection in patients who had a delay to reversal of ileostomy, compared to those who had no delay.
A retrospective cohort study was conducted of patients undergoing reversal of ileostomy at a single tertiary centre. A delay to reversal of ileostomy was defined if the procedure was performed at >365 days following the index procedure.
Clostridium difficile infection was defined as the presence of Clostridium difficile toxin associated with diarrhoea. Univariable logistic regression analysis was performed to estimate odds of the infection for each co-variable, comparing patients who had a delay to reversal of ileostomy with those who did not. Multivariable logistic regression analysis was used to adjust for the potential confounding effects of covariables.
The study results showed that of the 195 patients, 11 (5.6%), developed post-operative Clostridium difficile infection. Multivariable analysis showed that delay to reversal of ileostomy was associated with a nearly 7-fold increase in odds of Clostridium difficile infection (OR = 6.95, CI: 1.06-81.6; p-value =0.03).
As a result, the authors concluded that "a delay to reversal of ileostomy of >365 days was associated with a higher incidence of Clostridium difficile infection post-operatively. Careful consideration should be given to the timing of reversal and appropriate preoperative counselling of patients."
https://doi.org/10.1111/codi.15858