CDI Associated With Worse Outcomes After Certain Surgical Procedures

Clostridioides difficile infection (CDI) after surgery is differentially associated with hospital length of stay, costs, readmissions, and mortality across specific procedures in US patients, according to a study published in Surgery.

The study included nearly 400,000 patients in the US who underwent major cardiac, vascular, general, or oncologic procedures between 2015 and 2019. Among them, the incidence of CDI was 1.6%.

CDI was more common in patients who were older, had comorbidities, and underwent urgent surgery more frequently. CDI increased the median postoperative length of stay by 66% and hospital costs by 51%, according to the study.

Postoperative CDI was linked with increased readmissions after coronary artery bypass grafting, small bowel resection, colectomy, gastrectomy, pancreatectomy, and infrainguinal bypass; researchers reported an adjusted odds ratio range between 1.4 and 1.7. However, CDI was not associated with readmissions after open aneurysm repair, suprainguinal bypass, or esophagectomy.

Mortality was elevated in patients with postoperative CDI who had undergone coronary artery bypass grafting, small bowel resection, colectomy, and infrainguinal bypass, with an adjusted odds ratio range between 1.3 and 2.7, the study found. However, CDI had no effect on mortality in patients who had undergone open aneurysm repair, suprainguinal bypass, esophagectomy, gastrectomy, or pancreatectomy.

Increases in length of stay, cost, readmissions, and mortality were “most apparent after infrainguinal bypass, small bowel resection, colectomy, and coronary artery bypass grafting,” wrote corresponding author Jesse A. Columbo, MD, MS, of the Geisel School of Medicine at Dartmouth in Hanover, New Hampshire, and study coauthors. “Accordingly, a targeted Clostridium difficile reduction effort for these procedures may offer a more effective approach toward reducing infection rates.” 

Reference:

Columbo JA, Scali ST, Neal D, et al. Postoperative Clostridium difficile infection has a differential procedure-specific association with surgical outcomes in contemporary United States practice. Surgery. 2023;173(4):1015-1022. doi:10.1016/j.surg.2022.11.025