{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T18:54:38Z","timestamp":1790708078098,"version":"4.1.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2012,9,13]],"date-time":"2012-09-13T00:00:00Z","timestamp":1347494400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Only a small proportion of patients with severe Clostridium difficile infection (CDI) undergo emergency surgery, the timing and nature of which is unclear. The aim of this study was to describe the operations performed and to identify factors predictive of death following emergency surgery for CDI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review of published literature was performed for studies comparing survivors and non-survivors of emergency surgery for CDI. Meta-analysis was carried out for 30-day and in-hospital mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall 31 studies were included, which presented data on a total of 1433 patients undergoing emergency surgery for CDI. Some 1\u00b71 per cent of all patients with CDI and 29\u00b79 per cent with severe CDI underwent emergency surgery, although rates varied between studies (0\u00b72\u20137\u00b76 and 2\u00b72\u201386 per cent respectively). The most commonly performed operation was total colectomy with end ileostomy (89\u00b70 per cent, 1247 of 1401 detailed surgical procedures). When total colectomy with end ileostomy was not performed, reoperation to resect further bowel was needed in 15\u00b79 per cent (20 of 126). Where described, the 30-day mortality rate was 41\u00b73 per cent (160 of 387). Meta-analysis of high-quality studies revealed that the strongest predictors of postoperative death were those relating to preoperative physiological status: preoperative intubation, acute renal failure, multiple organ failure and shock requiring vasopressors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This systematic review supports total colectomy with end ileostomy as the primary surgical treatment for patients with severe CDI; other surgical procedures are associated with high rates of reoperation and mortality. Less extensive surgery may have a role in selected patients with earlier-stage disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bjs.8868","type":"journal-article","created":{"date-parts":[[2012,9,13]],"date-time":"2012-09-13T07:29:15Z","timestamp":1347521355000},"page":"1501-1513","source":"Crossref","is-referenced-by-count":135,"title":["Systematic review and meta-analysis of outcomes following emergency surgery for\n                    <i>Clostridium difficile<\/i>\n                    colitis"],"prefix":"10.1093","volume":"99","author":[{"given":"A","family":"Bhangu","sequence":"first","affiliation":[{"name":"West Midlands Research Collaborative, c\/o Professor D. Morton, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Nepogodiev","sequence":"additional","affiliation":[{"name":"West Midlands Research Collaborative, c\/o Professor D. Morton, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Gupta","sequence":"additional","affiliation":[{"name":"West Midlands Research Collaborative, c\/o Professor D. Morton, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Torrance","sequence":"additional","affiliation":[{"name":"West Midlands Research Collaborative, c\/o Professor D. Morton, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Singh","sequence":"additional","affiliation":[{"name":"West Midlands Research Collaborative, c\/o Professor D. Morton, Academic Department of Surgery, Room 29, 4th Floor, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2012,9,13]]},"reference":[{"key":"2021031109185778300_bib1","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1001\/archsurg.1992.01420070111020","article-title":"Laparotomy for fulminant pseudomembranous colitis","volume":"127","author":"Medich","year":"1992","journal-title":"Arch Surg"},{"key":"2021031109185778300_bib2","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1111\/j.1463-1318.2005.00876.x","article-title":"The outcome of surgery in fulminant Clostridium difficile colitis","volume":"8","author":"Koss","year":"2006","journal-title":"Colorectal Dis"},{"key":"2021031109185778300_bib3","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1007\/DCR.0b013e31819a69aa","article-title":"Risk factors for mortality following emergency colectomy for fulminant Clostridium difficile infection","volume":"52","author":"Pepin","year":"2009","journal-title":"Dis Colon Rectum"},{"key":"2021031109185778300_bib4","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1097\/01.sla.0000236628.79550.e5","article-title":"Impact of emergency colectomy on survival of patients with fulminant Clostridium difficile colitis during an epidemic caused by a hypervirulent strain","volume":"245","author":"Lamontagne","year":"2007","journal-title":"Ann Surg"},{"key":"2021031109185778300_bib5","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1001\/archsurg.2007.46","article-title":"Predictors of mortality after colectomy for fulminant Clostridium difficile colitis","volume":"143","author":"Byrn","year":"2008","journal-title":"Arch Surg"},{"key":"2021031109185778300_bib6","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.surg.2007.12.008","article-title":"Risk factors for the development of fulminant Clostridium difficile colitis","volume":"143","author":"Greenstein","year":"2008","journal-title":"Surgery"},{"key":"2021031109185778300_bib7","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.surge.2010.06.003","article-title":"Outcomes of emergency colectomy for fulminant Clostridium difficile colitis","volume":"8","author":"Al-Abed","year":"2010","journal-title":"Surgeon"},{"key":"2021031109185778300_bib8","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1177\/000313481007600421","article-title":"Colectomy for fulminant Clostridium difficile colitis: predictors of mortality","volume":"76","author":"Perera","year":"2010","journal-title":"Am Surg"},{"key":"2021031109185778300_bib9","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1001\/archsurg.2009.51","article-title":"Fulminant Clostridium difficile colitis: patterns of care and predictors of mortality","volume":"144","author":"Sailhamer","year":"2009","journal-title":"Arch Surg"},{"key":"2021031109185778300_bib10","doi-asserted-by":"crossref","first-page":"1620","DOI":"10.1007\/s10350-004-0672-2","article-title":"Outcome after colectomy for Clostridium difficile colitis","volume":"47","author":"Longo","year":"2004","journal-title":"Dis Colon Rectum"},{"key":"2021031109185778300_bib11","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1097\/SLA.0b013e31822ade48","article-title":"Diverting loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for the treatment of severe, complicated Clostridium difficile associated disease","volume":"254","author":"Neal","year":"2011","journal-title":"Ann Surg"},{"key":"2021031109185778300_bib12","doi-asserted-by":"crossref","first-page":"b2700","DOI":"10.1136\/bmj.b2700","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"BMJ"},{"key":"2021031109185778300_bib13","volume-title":"Third Symposium on Systematic Reviews: Beyond the Basics. Improving Quality and Impact","author":"Wells","year":"2000"},{"key":"2021031109185778300_bib14","doi-asserted-by":"crossref","first-page":"820","DOI":"10.7326\/0003-4819-127-9-199711010-00008","article-title":"Quantitative synthesis in systematic reviews","volume":"127","author":"Lau","year":"1997","journal-title":"Ann Intern Med"},{"key":"2021031109185778300_bib15","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials","volume":"7","author":"DerSimonian","year":"1986","journal-title":"Control Clin Trials"},{"key":"2021031109185778300_bib16","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1177\/000313480807400105","article-title":"Early surgical intervention for fulminant pseudomembranous colitis","volume":"74","author":"Ali","year":"2008","journal-title":"Am Surg"},{"key":"2021031109185778300_bib17","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1002\/ibd.21457","article-title":"Temporal trends in disease outcomes related to Clostridium difficile infection in patients with inflammatory bowel disease","volume":"17","author":"Ananthakrishnan","year":"2011","journal-title":"Inflamm Bowel Dis"},{"key":"2021031109185778300_bib18","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.ijsu.2008.11.002","article-title":"Outcomes following colectomy for Clostridium difficile colitis","volume":"7","author":"Chan","year":"2009","journal-title":"Int J Surg"},{"key":"2021031109185778300_bib19","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1097\/00000658-200203000-00008","article-title":"Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications","volume":"235","author":"Dallal","year":"2002","journal-title":"Ann Surg"},{"key":"2021031109185778300_bib20","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s11605-009-1093-2","article-title":"C. difficile colitis \u2013 predictors of fatal outcome","volume":"14","author":"Dudukgian","year":"2010","journal-title":"J Gastrointest Surg"},{"key":"2021031109185778300_bib21","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1308\/003588410X12518836439164","article-title":"Emergency subtotal colectomy for fulminant Clostridium difficile colitis\u2014is a surgical solution considered for all patients?","volume":"92","author":"Gash","year":"2010","journal-title":"Ann R Coll Surg Engl"},{"key":"2021031109185778300_bib22","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1007\/BF02056938","article-title":"Clostridium difficile colitis in the critically ill","volume":"39","author":"Grundfest-Broniatowski","year":"1996","journal-title":"Dis Colon Rectum"},{"key":"2021031109185778300_bib23","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.amjsurg.2007.11.017","article-title":"Outcome of colectomy for Clostridium difficile colitis: a plea for early surgical management","volume":"196","author":"Hall","year":"2008","journal-title":"Am J Surg"},{"key":"2021031109185778300_bib24","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1007\/s11605-008-0569-9","article-title":"Clostridium difficile infection: a surgical disease in evolution","volume":"12","author":"Hermsen","year":"2008","journal-title":"J Gastrointest Surg"},{"key":"2021031109185778300_bib25","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.cgh.2006.12.028","article-title":"Impact of Clostridium difficile on inflammatory bowel disease","volume":"5","author":"Issa","year":"2007","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2021031109185778300_bib26","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/S0002-9610(99)80199-8","article-title":"Clostridium difficile colitis: an increasing hospital-acquired illness","volume":"169","author":"Jobe","year":"1995","journal-title":"Am J Surg"},{"key":"2021031109185778300_bib27","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1378\/chest.07-0202","article-title":"Analysis of 30-day mortality for Clostridium difficile-associated disease in the ICU setting","volume":"132","author":"Kenneally","year":"2007","journal-title":"Chest"},{"key":"2021031109185778300_bib28","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1159\/000018821","article-title":"Acute abdomen and Clostridium difficile colitis: still a lethal combination","volume":"17","author":"Klipfel","year":"2000","journal-title":"Dig Surg"},{"key":"2021031109185778300_bib29","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1007\/DCR.0b013e3182060904","article-title":"In-hospital and 6-month mortality rates after open elective vs open emergent colectomy in patients older than 80 years","volume":"54","author":"Kurian","year":"2011","journal-title":"Dis Colon Rectum"},{"key":"2021031109185778300_bib30","first-page":"491","article-title":"Pseudomembranous colitis: a surgical disease?","volume":"116","author":"Lipsett","year":"1994","journal-title":"Surgery"},{"key":"2021031109185778300_bib31","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1177\/000313481107700813","article-title":"Predictors of fatal outcome after colectomy for fulminant Clostridium difficile colitis: a 10-year experience","volume":"77","author":"Markelov","year":"2011","journal-title":"Am Surg"},{"key":"2021031109185778300_bib32","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1001\/archsurg.137.10.1096","article-title":"Clostridium difficile colitis: an increasingly aggressive iatrogenic disease?","volume":"137","author":"Morris","year":"2002","journal-title":"Arch Surg"},{"key":"2021031109185778300_bib33","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1086\/502539","article-title":"A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use","volume":"26","author":"Muto","year":"2005","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2021031109185778300_bib34","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1007\/BF02054220","article-title":"Severe Clostridium difficile colitis","volume":"38","author":"Rubin","year":"1995","journal-title":"Dis Colon Rectum"},{"key":"2021031109185778300_bib35","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.amjsurg.2008.11.001","article-title":"Early colectomy may be associated with improved survival in fulminant Clostridium difficile colitis: an 8-year experience","volume":"197","author":"Seder","year":"2009","journal-title":"Am J Surg"},{"key":"2021031109185778300_bib36","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1046\/j.1365-2168.1998.00519.x","article-title":"Timing of surgery for fulminating pseudomembranous colitis","volume":"85","author":"Synnott","year":"1998","journal-title":"Br J Surg"},{"key":"2021031109185778300_bib37","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1007\/BF02133974","article-title":"Toxic megacolon complicating pseudomembranous enterocolitis","volume":"38","author":"Trudel","year":"1995","journal-title":"Dis Colon Rectum"},{"key":"2021031109185778300_bib38","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1002\/ibd.20500","article-title":"Clostridium difficile and inflammatory bowel disease","volume":"14","author":"Issa","year":"2008","journal-title":"Inflamm Bowel Dis"},{"key":"2021031109185778300_bib39","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1111\/j.1463-1318.2009.01832.x","article-title":"Mortality and risk stratification in patients with Clostridium difficile-associated diarrhoea","volume":"12","author":"Bhangu","year":"2010","journal-title":"Colorectal Dis"},{"key":"2021031109185778300_bib40","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.jinf.2007.09.015","article-title":"Outcome of metronidazole therapy for Clostridium difficile disease and correlation with a scoring system","volume":"55","author":"Belmares","year":"2007","journal-title":"J Infect"},{"key":"2021031109185778300_bib41","doi-asserted-by":"crossref","first-page":"621","DOI":"10.2310\/JIM.0b013e3181d5d9e0","article-title":"Optimum timing of blood tests for monitoring patients with Clostridium difficile-associated diarrhea","volume":"58","author":"Bhangu","year":"2010","journal-title":"J Investig Med"},{"key":"2021031109185778300_bib42","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1007\/s11605-009-0819-5","article-title":"Long-term follow-up of patients with fulminant Clostridium difficile colitis","volume":"13","author":"Miller","year":"2009","journal-title":"J Gastrointest Surg"}],"container-title":["British Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbjs.8868","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/academic.oup.com\/bjs\/article-pdf\/99\/11\/1501\/36543129\/bjs8868.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/bjs\/article-pdf\/99\/11\/1501\/36543129\/bjs8868.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T10:07:25Z","timestamp":1621505245000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/99\/11\/1501-1513\/6138640"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,9,13]]},"references-count":42,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2012,9,13]]},"published-print":{"date-parts":[[2012,10,1]]}},"URL":"https:\/\/doi.org\/10.1002\/bjs.8868","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.717958397.793464803","asserted-by":"object"},{"id-type":"doi","id":"10.3410\/f.717958397.793463515","asserted-by":"object"},{"id-type":"doi","id":"10.3410\/f.717958397.793464481","asserted-by":"object"},{"id-type":"doi","id":"10.3410\/f.717958397.793464178","asserted-by":"object"}]},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"value":"0007-1323","type":"print"},{"value":"1365-2168","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2012,11]]},"published":{"date-parts":[[2012,9,13]]}}}