Introduction: Hospital-acquired C. difficile infection, resulting in pseudomembranous colitis, 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 associated with C. difficile infection in patients after lumbar spine surgery. The purpose of this study was to investigate incidence, comorbidities and impact on health care resources of Clostridium difficile infection after lumbar 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 lumbar spine surgery and further substratified to degenerative diagnoses. Baseline patient characteristics such as age, insurance type, major comorbidities, costs and mortality rate were determined. Multivariable analyses assessed factors increasing incidence of diagnosis and factors associated with inpatient mortality.
Results: Incidence of C. difficile infection in postoperative lumbar spine surgery patients is .11%. At baseline, C. difficile patients have an increased incidence of comorbidities such as diabetes with chronic complications, congestive heart failure, coagulopathy and pulmonary circulatory disorders. Lumbar fusion (p = .0001) and fusion revision (p = .0003) are associated with increased incidence when compared to posterior lumbar decompression. Likewise, Medicaid (p < .0001) and those uninsured (p < .0001) have an increased incidence when compared to private insurance. Small hospitals (p = .001) are associated with decreased likelihood of infection when compared to large hospitals. C. difficile results in extended length of stay (p < .0001) and higher median costs (p < .0001). A total of 4.0% of patients with C. difficile infection died versus .11% of patients without C. difficile (p < .0001). Multivariable analysis for inpatient mortality indicates that C. difficile greatly increases mortality (9.60 odds ratio, p < .0001).
Conclusions: C. difficile carries a 36.4 fold increase in mortality and costs approximately $10,658,646 per year to manage—a significant impact on healthcare resources. Novel and difficult to treat antibiotic resistant strains may be reduced if proper antibiotic administration is practiced in this population.
Patient Care: Raise awarness of the impact of C.difficile infection after lumbar spine surgery
Learning Objectives: 1) Identify C. difficile infectionas an independent risk factor for increased mortality after lumbar spine surgery