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In an analysis of the literature from January 1989 to May 2009, earlier diagnosis and treatment with subtotal colectomy and end-ileostomy reduced mortality associated with fulminant CDI (75). One study demonstrated a trend toward decreased mortality rates in patients with fulminant disease who underwent colectomy compared with those who did not (42).
These investigators further showed that admission of patients with complicated CDI to a surgical service was associated with a decreased mortality and a shorter mean interval from admission to operation compared with admission to a non-surgical service.
Currently, there is no scoring system that creates a threshold for operative management.