Presentation Authors: Kevin Ginsburg*, Andrew Mcelroy, Detroit, MI, Alex Tapper, Frank Burks, Royal Oak, MI, Michael Cher, Amarnath Rambhatla, Detroit, MI
Introduction: Clostridium difficile infection (CDI) is a hospital acquired infection that can cause significant perioperative morbidity. We sought to characterize the incidence, risk factors, and impact of CDI on perioperative outcomes in urologic surgery.
Methods: The American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database tracts 30-day hospital readmission, reoperation, death, and complications, including CDI, from participating institutions. We identified CPT codes of patients undergoing the breadth of urologic surgery, which we characterized into 12 surgical categories (Figure 1). Univariate analysis was used to compare preoperative and operative parameters associated with the outcomes of interest (CDI, readmission, and death). Variables that were significant or near significant were entered into a multivariable backwards stepwise logistic regression model. All tests were 2 sided and significance was set at p=0.05.
Results: From 2015-2016, we identified 83,646 patients with urology associated CPT codes, of which 281 patients (0.3%) developed postoperative CDI. CDI was highest in patients undergoing urinary diversion with (2.6%) or without cystectomy (3.6%), Figure 1. In the multivariable model, male gender was protective against CDI (OR 0.657, 95% CI 0.452-0.925, p=0.017) while low serum albumin ( < 3.5mg/dL) and elevated serum creatinine (>1.5mg/dL) were associated with CDI (OR 1.89, 95% CI 1.33-2.68, p < 0.001, and OR 1.89, 95% CI 1.29-2.89, p=0.001, respectively). Increasing age per year (OR 1.02, 95% CI 1.001-1.03, p=0.03), operative time per minute (OR 1.002, 95% CI 1.001-1.003, p=0.001), and postoperative length of stay (OR 1.054, 95% CI 1.039-1.070, p < 0.001) were each associated with the development of CDI. CDI was significantly associated with 30-day hospital readmission (OR 4.24, 95% CI 3.04-5.91, p < 0.001) and 30-day mortality (OR 4.35, 95% CI 2.26-8.35, p < 0.001).
Conclusions: Although, CDI is relatively uncommon in most urologic surgery, there is significant morbidity and mortality associated with CDI. Awareness of predisposing risk factors may provide insight to decrease the incidence and impact of CDI.