The Burden and Risk Factors of Postoperative C. difficile Infection in Surgical Patients in the US: The Hospital Effect

Author(s):
Dias Argandykov; Jefferson Proaño-Zamudio; Angela Renne; May Abiad; Casey Luckhurst; Jonathan Parks; Charudutt N. Paranjape; David King; John Hwabejire; George Velmahos; Haytham Kaafarani; Michael P. DeWane

Background:

Clostridioides difficile infection (CDI) is a common postoperative complication. While patient-level CDI risk factors have been well-established, there remains a lack of studies examining hospital-level characteristics associated with postoperative CDI.

Methods:

The National Readmission Database 2019 was utilized to identify adult patients who developed postoperative CDI following general surgery (GS) procedures. Patients with CDI undergoing colectomy/ileostomy in the absence of any other GI condition were excluded. Propensity score matching was performed to compare outcomes between patients with and without CDI. The main outcomes were in-hospital, 30 & 90-day mortality, readmission rates, and costs. Logistic regression was performed to identify patient-, procedure-, and hospital-level factors associated with CDI.

Results:

A total of 362,631 GS patients were identified. The incidence of postoperative CDI was 0.38%. After propensity matching, there was no difference in in-hospital mortality between patients with and without CDI (5.1% vs. 5.6%, p=0.56). However, patients with CDI had increased length of stay, costs and higher rates of unplanned 30 & 90-day readmission [Table 1]. Older age, weight loss, paralysis, higher severity of illness, and specific surgical procedures such as small bowel resection and ileostomy/colostomy placement, were associated with a higher risk of CDI. Among hospital-related characteristics, private investor-owned hospitals were associated with a decreased risk of CDI [Table 2].

Conclusions:

CDI is associated with increased costs, readmissions and length of stay in GS patients, and is less common in investor-owned hospitals. Future studies are needed to examine how differences in antimicrobial stewardship programs, infection control measures, and complication reporting may differ across hospitals and may represent potential targets for improvement efforts.