Influence of prior appendectomy and cholecystectomy on Clostridioides difficile infection recurrence and mortality

Remote appendectomy was linked to increased incidence of Clostridioides difficile infection (CDI). We evaluated the effect of absence of vermiform appendix and/or gallbladder on recurrence rate and severity of CDI.

We assessed a systemwide patient cohort diagnosed with initial CDI in 2014 (n = 250). The primary outcome was recurrence.

Appendix and gallbladder were absent among 47 and 64 patients, respectively. CDI recurrence rate was similar among patients without and with appendix (24/47, 51.1% versus 90/203 patients, 44.3%; p = 0.404) and similar among patients without and with gallbladder (29/64 patients, 45.3% versus 85/186 patients, 45.7%; p = 0.957). Mortality was similar between appendectomy versus appendix in situ patients (3/47, 6.4% versus 9/203, 4.4%; p = 0.573), but higher mortality rate was seen among those without gallbladder (7/64 patients with prior cholecystectomy, 10.9% versus 5/186 patients with intact gallbladder, 2.7%; p = 0.008).

Clostridioides difficile recurrence rate is not affected by remote appendectomy or cholecystectomy. Patients with prior cholecystectomy experience higher mortality rates associated with their CDI.