PREDICTING POST-OPERATIVE CLOSTRIDIUM DIFFICILE INFECTION
Tara M. Barry*, Anthony J. DeSantis, Haroon M. Janjua, Evelena Cousin-Peterson, Adham Saad, PAUL KUO
Surgery, University of South Florida/Tampa General Hospital, Tampa, FL
Introduction: Post-operative Clostridium Difficile infection is a challenging complication that can significantly extend length of stay, increase costs, and if it is not recognized promptly can lead to fulminant colitis and death. The purpose of this study was to identify pre-operative factors that predispose patients to developing post-operative Clostridium Difficile Colitis.
Methods: A retrospective observational study was performed using the American College of Surgeons National Surgical Quality Improvement Program database from 2015-2017. Cases from all sub specialties were included and C.Diff cases were identified as either occurrence of post op c.diff colitis complication, reoperation or readmission for c.diff colitis using ICD-9 and ICD-10 codes. One-to-two propensity matching was performed to compare patients who developed post-operative C.diff with those who did not, based on patient sex, age, race, ethnicity, preoperative labs (WBC/albumin), frailty index, functional status, comorbidities, preoperative infection, ASA class, case classification and surgical subspecialty. Backwards stepwise logistic regression was used to predict the occurrence of post-operative C.diff infection. T test and Chi Square test were used for statistical analysis.
Results: Of 2.9 million patients, 10,178 developed post-operative C.diff. After one to two matching of C.diff to non-C.diff patients, 30,633 patients remained. General Surgery was the most common specialty (63.98%) followed by Orthopedics (10.7%), Vascular (9.54%), Urology (5.78%) and Neurosurgery (3%). The AUC for the predictive model was 0.77. The top positive predictors of post-operative C.diff infection in the complete model were: still in hospital >30 days, ASA class IV or V, required reoperation during admission, wound class contaminated. The top positive predictors of post-operative C.diff infection after propensity matching were: patient required readmission, outpatient procedure, wound class: contaminated, and surgical specialty was Orthopedics or Neurosurgery. Patients readmitted to the hospital for any reason were 6 times more likely to develop post-operative C.diff (p<0.01) and more patients who developed C.diff died in the hospital (4.09% vs 3.18%, p<0.01).
Conclusion: Post-operative C.diff infection was documented in only 0.35% of patients from the NSQIP database, however they had a higher rate of in hospital mortality than their counterparts. Providers should be vigilant to diagnose C.diff in post-operative patients who are readmitted or require reoperation, and those with high ASA class are especially vulnerable.
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