A160 CLOSTRIDIUM DIFFICILE AFTER LAPARASCOPIC BARIATRIC SURGERY: AN ANALYSIS OF THE METABOLIC AND BARIATRIC SURGERY ACCREDITATION AND QUALITY IMPROVEMENT PROGRAM. (15th March 2019) - Dang, T
Abstract: Background: Obesity is associated with disturbances in the gut microbiota and reduced microbial diversity, both of which are risk factors for Clostridium difficile infection (CDI). Patients undergoing bariatric surgery incur substantive changes to their gut microbiota which may affect their risk for developing CDI. Aims: 1. Assess the risk of developing postoperative CDI within 30 days after laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) is a clinically-rich database that captures variables specific to bariatric surgery from 791 centers in the United States and Canada. We identified all patients undergoing LRYGB or LSG in 2016. Patients undergoing revisional bariatric surgery were excluded. Primary outcomes of interest included the prevalence and predictors of CDI after bariatric surgery. A purposeful selection algorithm was used to develop a multivariable logistic regression model to determine preoperative factors predictive of 30-day CDI. Results: A total of 38, 737 LRYGB and 106, 133 LSG were included. Mean age was 44.6 ± 12.0 years, 79.5% were female and mean body mass index was 45.3 ± 7.8 kg/m 2 . Mean operative time was 85.1 ± 46.9 minutes. The overall incidence of CDI among patients undergoing LRYGB or LSG was low with only 204 patients (0.14%) developing CDI. However, the incidence of CDI was significantly higher in the LRYGB cohort (0.20 vs 0.12%, p < 0.001). Although incidence was low, CDI was associated with increased major complications including leak (2.5 vs 0.4%, p < 0.001), bleed (3.4 vs 0.9%, p < 0.001), sepsis (2.5 vs 0.1%, p < 0.001), and others (Table 1 ). Patients with CDI also had significantly higher rates of reoperations (7.8 vs 1.2%, p < 0.001), non-operative reinterventions (10.3 vs 1.3%, p < 0.001), and readmissions (52.5 vs 3.7%, p < 0.001). Multivariable logistic regression determined the following factors that were independently predictive of CDI: LRYGB (OR 1.42, CI 1.04–1.95, p = 0.030), female sex (OR 1.74, CI 1.17–2.59, p = 0.006), white race (OR 1.89, 1.30–2.76, p = 0.001), previous VTE (OR 2.57, CI 1.43–4.64, p = 0.002), smoking (OR 1.65, CI 1.10–2.46, p=0.015), poor functional status OR 2.59, CI 1.09–6.14, p = 0.030), and prolonged operative time (OR 1.21, CI 1.04–1.41, p = 0.016). Conclusions: The overall risk of CDI after bariatric surgery is low, even compared to inpatient surgical patients in which rates have been reported to be as high as 0.5% in other studies. Compared to LSG, LRYGB is associated with an elevated risk of developing CDI within the first 30 days after surgery. This increased risk may be a result of changes in gut microbiota which is seen more in in LRYGB compared to LSG. Funding Agencies: None