Clostridium difficile colitis portends poor outcomes in lower extremity orthopaedic trauma surgery. Issue 10 (October 2022)

• Record Type: Journal Article
• Authors: Gonzalez, Christian A.; Van Rysselberghe, Noelle L.; Maschhoff, Clayton; Gardner, Michael J.
• Is Part Of: Injury. Volume 53:Issue 10(2022)
• Page Start: 3458
• Page End: 3463
• Publication Date: 2022-10
• Subjects: Clostridium difficile -- Colitis -- Lower extremity fracture -- Hip fracture -- Orthopedic trauma; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2022.08.026
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: The incidence of C. difficile colitis (CDC) in lower extremity orthopedic trauma patients was 0.59%. CDC was associated with increased 30 day mortality, readmission, and length of stay. These findings may help inform family counseling and adjustments to bundled payments. Mitigating the spread of c. difficile is paramount to decreasing the burden this infection imposes on patients and the healthcare system. Abstract: Introduction: Clostridium difficile is the most common cause of healthcare-associated infectious diarrhea and colitis, and carries the potential for high morbidity, particularly in frail patient populations. The purpose of this study was to utilize a large nationally representative database in order to report 1.) the incidence of CDC in patients with operative lower extremity fractures, 2.) risk factors for the development of CDC, 3.) the association of CDC with length of stay (LOS), readmission, and 30-day mortality rates. Methods: The ACS-NSQIP (2015–2019) was queried for patients who underwent surgical fixation of lower extremity fractures. A backward elimination multivariate regression model was used to identify risk factors for CDC. Chi squared and multivariate regression that controlled for preoperative variables and comorbidities were used to compare outcomes in patients with and without CDC. Results: 95, 532 patients were included, 681 (0.71%) of whom developed CDC. Risk factors for CDC were advanced age, ASA class ≥ 3, smoking, dialysis, anemia, hypoalbuminemia, preoperative SIRS, preoperative wound infections, preoperative sepsis, and the use of spinal anesthesia or MAC/IV sedation. Patients with CDC had significantly increased 30-day mortality rates (10.6% vs 4.4%; OR 1.80, 95% CI 1.41–2.31), readmission (34.2% vs 7.5%; OR 5.13, 95% CI 4.36–6.05, and length of stay (7.5 days vs 5.3 days) compared to patients without CDC. Conclusion: The incidence of CDC in lower extremity orthopedic trauma patients was 0.71%. An occurrence of CDC was associated with approximately a 2.5 times increase in 30-day mortality, five times the readmission rate, and a longer hospital stay compared to patients without CDC. Mitigating the spread of c. diff through improved antibiotic stewardship and prompt treatment of CDC is paramount to decreasing the burden this infection imposes on orthopedic trauma patients and the healthcare system.