Delays in Surgery for Patients With Coronary Stents Placed After Diagnosis of Colorectal Cancer

The increase in mortality could be attributed to changes in the virulence of the C difficile strains, although we are unable to determine this owing to the limitations of the data set.We were unable to examine variables such as antibiotic regimen, severity of disease, physical examination findings, immunosuppression, presence of end-organ failure, patient frailty status, Acute Physiology and Chronic Health Evaluation score, and signs of sepsis and leukocytosis, which have been identified as factors associated with mortality in prior published reports. 3Another limitation of this database is the use of ICD-9 codes rather than the use of clinical and radiographic criteria, which are not available in this database.The mortality rates associated with C difficile-associated megacolon have been reported to range from 38% to 80%, with early diagnosis crucial in improving mortality, but they are based on case studies and case series. 4-6The Nationwide Inpatient Sample database is limited to single admissions; further study is needed to examine long-term survival among these patients.By using a national data set spanning a decade (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010), we were able to study the largest group to date.This study draws attention to the tremendous burden of C difficile on patient mortality, health care costs and resources, and transitional care and the need for aggressive prevention of this iatrogenic disease.Despite the rarity of C difficile-associated megacolon, our findings suggest that health care professionals should have a heightened suspicion of megacolon in patients with C difficile infection and a lower threshold for transferring infected patients to intensive care units, where goal-directed resuscitation is most feasible.