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  • The Burden of Clostridium Difficile After Cervical Spine Surgery

    Final Number:

    Branko Skovrlj MD; Javier Zabdi Guzman; Sheeraz Qureshi

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Hospital-acquired C. difficile infection confers significant morbidity and mortality. The pathophysiology of this infection is associated with alterations in the physiologic gut flora that can be affected by perioperative antibiotic use. The purpose of this study was to investigate incidence, comorbidities and impact on health care resources of Clostridium difficile infection after cervical spine surgery.

    Methods: The National Inpatient Sample was examined from 2002 to 2011. Patients were included for study based on ICD-9-CM procedural codes for cervical spine surgery for degenerative spine diagnoses. Baseline patient characteristics were determined. Multivariable analyses assessed factors associated with increased incidence of C. difficile and risk of mortality.

    Results: Incidence of C. difficile infection in postoperative cervical spine surgery hospitalizations is 0.08% and is significantly increasing since 2002 (p = .023). At baseline, C. difficile patients were more likely to have diabetes with chronic complications and renal failure. Combined anterior posterior cervical fusion (p < .0001) increased the likelihood of developing postoperative C. difficile infection. Anterior cervical spine fusion is associated with decreased incidence when compared to posterior cervical decompression with fusion (p = .001). Medicare, Medicaid, and those uninsured leaned towards increasing incidence as compared to private insurance; however, did not reach statistical significance. C. difficile infection after cervical spine surgery results in extended length of stay (p < .0001) and increased hospital costs (p < .0001). Mortality rate in patients who develop C. difficile after cervical spine surgery is nearly 8% versus 0.19% otherwise (p < .0001).

    Conclusions: C. difficile infection carries a 41.6 fold increase in mortality and costs approximately $6,830,695 per year to manage—a significant impact on healthcare resources. Increasing incidence and novel antibiotic resistant strains may be reduced if proper antibiotic protocols are followed in this population.

    Patient Care: Increase awarness

    Learning Objectives: 1)Awarness of C.difficile infection on outcomes after cervical spine surgery


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