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    Clostridium difficile infection after colorectal surgery: a rare but costly complication

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    Authors
    Damle, Rachelle N.
    Cherng, Nicole B.
    Flahive, Julie
    Davids, Jennifer S.
    Maykel, Justin A.
    Sturrock, Paul R.
    Sweeney, W. Brian
    Alavi, Karim
    Student Authors
    Prabhakar Mithal
    Faculty Advisor
    Karim Alavi, MD/Surgery
    UMass Chan Affiliations
    Department of Surgery
    School of Medicine
    Senior Scholars Program
    Document Type
    Journal Article
    Publication Date
    2014-10-01
    Keywords
    Adolescent
    Adult
    Clostridium difficile
    Colorectal Surgery
    Cost-Benefit Analysis
    Enterocolitis, Pseudomembranous
    Female
    Follow-Up Studies
    Hospital Costs
    Humans
    Length of Stay
    Male
    Middle Aged
    Prevalence
    Prognosis
    Retrospective Studies
    Risk Assessment
    Risk Factors
    Surgical Wound Infection
    Time Factors
    United States
    Young Adult
    Surgery
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    Link to Full Text
    http://dx.doi.org/10.1007/s11605-014-2600-7
    Abstract
    BACKGROUND: The incidence and virulence of Clostridium difficile infection (CDI) are on the rise. The characteristics of patients who develop CDI following colorectal resection have been infrequently studied. MATERIALS AND METHODS: We utilized the University HealthSystem Consortium database to identify adult patients undergoing colorectal surgery between 2008 and 2012. We examined the patient-related risk factors for CDI and 30-day outcomes related to its occurrence. RESULTS: A total of 84,648 patients met our inclusion criteria, of which the average age was 60 years and 50% were female. CDI occurred in 1,266 (1.5%) patients during the years under study. The strongest predictors of CDI were emergent procedure, inflammatory bowel disease (IBD), and major/extreme APR-DRG severity of illness score. CDI was associated with a higher rate of complications, intensive care unit (ICU) admission, longer preoperative inpatient stay, 30-day readmission rate, and death within 30 days compared to non-CDI patients. Cost of the index stay was, on average, $14,130 higher for CDI patients compared with non-CDI patients. CONCLUSION: Emergent procedures, higher severity of illness, and inflammatory bowel disease are significant risk factors for postoperative CDI in patients undergoing colorectal surgery. Once established, CDI is associated with worse outcomes and higher costs. The poor outcomes of these patients and increased costs highlight the importance of prevention strategies targeting high-risk patients.
    Source
    J Gastrointest Surg. 2014 Oct;18(10):1804-11. doi: 10.1007/s11605-014-2600-7. Epub 2014 Aug 5. Link to article on publisher's site
    DOI
    10.1007/s11605-014-2600-7
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/49283
    PubMed ID
    25091840
    Notes

    Nichole Cherng participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School.

    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1007/s11605-014-2600-7
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    T.H. Chan School of Medicine Student Publications
    Senior Scholars Program

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