2023 General Surgery Presentations

Joseph Gutierrez, MD; Daniel Chen, MD, MPH, TM; Dylan Russell, MD; Christopher Yheulon, MD, FACS, FASMBS; Tripler Army Medical Center

Introduction: Clostridioides difficile infection (CDI) continues to be a prevalent nosocomial infection. The appendix has recently been hypothesized to act as a reservoir for favorable enteric bacteria to restore the normal intestinal microbiome, possibly preventing CDI in the setting of antibiotic use. This study aims to compare the rates of post-operative CDI among patients undergoing elective colectomy for colon cancer with and without the removal of the appendix.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) targeted colectomy database was queried from 2005-2020 for patients undergoing a primary procedure of elective colectomy for an indication of colon cancer without other or concurrent procedures performed. Patients were divided into two groups: those undergoing colectomy with ileo-colic anastomosis (Right colectomy - CPT codes 44160 and 44205) and colo-colic anastomosis (Segmental Colectomy - CPT codes 44140 and 44204). Patients with peri-operative infections including sepsis, wound infection, pneumonia, urinary tract infection, and surgical site infection were excluded. The two groups were matched on demographic and peri-operative factors. The primary outcome was CDI within 30 days of surgery.

Results: A total of 90,086 patients were identified with 6,126 meeting inclusion criteria. After matching, a total of 5,662 patients remained with 2,831 in both groups. A standardized mean difference (SMD) less than 0.1 was achieved for all covariates except for oral antibiotic bowel preparation (61.3% vs 64.1%, SMD 0.119) and operative time (143 vs 161 minutes, SMD 0.276). A total of 51 patients (0.9%) developed CDI postoperatively and rates of infection were similar between the two groups (0.92% vs 0.88%, p=1)

Conclusion: Among patients undergoing elective colectomy for colon cancer, there is no difference in short term post-operative CDI for patients undergoing right colectomy – ensuring surgical absence of the appendix - compared to segmental colectomy. Further research must be performed examining if there is any long-term impact of the appendix on CDI.