Abstract
Background
The Centers for Disease Control and Prevention has made the prevention of in-hospital
Clostridium difficile infection a priority. However, whether there is a differential impact of Clostridium difficile on surgical patients remains undefined. Therefore, we quantified the procedure-specific
association between postoperative Clostridium difficile and surgical outcomes to define opportunities for targeted quality improvement.
Methods
We studied patients undergoing major cardiac, vascular, general, or oncologic procedures
using the Vizient database from 2015 to 2019. Our primary exposure was postoperative
Clostridium difficile infection. Our primary outcomes were postoperative length of stay, hospitalization
cost, readmission, and in-hospital mortality. We used linear and logistic regression
for risk adjustment.
Results
The incidence of Clostridium difficile infection was 1.6% (n = 6,506/397,750). Patients with Clostridium difficile were older, more comorbid, and more frequently underwent urgent surgery. The median
postoperative length of stay was 7 days (interquartile range: 5–11 days), and it was
66% longer among those with Clostridium difficile (P < .001). Similarly, the median hospitalization cost was $31,000 (interquartile range:
$20,000–$49,000), and it was 51% greater among patients with Clostridium difficile (P < .001). Postoperative Clostridium difficile was associated with more readmissions after coronary artery bypass grafting, small
bowel resection, colectomy, gastrectomy, pancreatectomy, and infrainguinal bypass
(adjusted odds ratio range: 1.4–1.7), but not after open aneurysm repair, suprainguinal
bypass, or esophagectomy. Clostridium difficile was associated with increased mortality after coronary artery bypass grafting, small
bowel resection, colectomy, and infrainguinal bypass (adjusted odds ratio range: 1.3–2.7),
but not after open aneurysm repair, suprainguinal bypass, esophagectomy, gastrectomy,
or pancreatectomy.
Conclusion
Postoperative Clostridium difficile infection was differentially associated with increased length of stay, cost, readmissions,
and mortality across specific procedures. This was most apparent after infrainguinal
bypass, small bowel resection, colectomy, and coronary artery bypass grafting. Accordingly,
a targeted Clostridium difficile reduction effort for these procedures may offer a more effective approach toward
reducing infection rates.
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Article info
Publication history
Published online: December 19, 2022
Accepted:
November 21,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
