Analysis of Clostridium difficile infections after cardiac surgery: Epidemiologic and economic implications from national data

Andrew Flagg, Colleen G. Koch, Nicholas Schiltz, Aiswarya Chandran Pillai, Steven M. Gordon, Gösta B. Pettersson, Edward G. Soltesz

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives Clostridium difficile infections (CDIs) have increased during the past 2 decades, especially among cardiac surgical patients, who share many of the comorbidity risk factors for CDI. Our objectives were to use a large national database to identify the regional-, hospital-, patient-, and procedure-level risk factors for CDI; and determine mortality, resource usage, and cost of CDIs in cardiac surgery.

Methods Using the Nationwide Inpatient Sample database, we identified 349,122 patients who had undergone coronary artery bypass, valve, or thoracic-aortic surgery from 2004 to 2008. Of these, 2581 (0.75%) had been diagnosed with CDI. Multivariable regression analysis and the propensity method were used for risk adjustment.

Results Compared with the West, CDIs were more likely to occur in the Northeast (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.12-1.47) and Midwest (OR, 1.27, 95% CI, 1.11-1.46) and less likely in the South (OR, 0.80; 95% CI, 0.70-0.90). Medium-size hospitals (OR, 0.88; 95% CI, 0.78-0.99) had a lower risk of CDI than did large hospitals. Older age (>75 years; OR, 2.59; 95% CI, 1.93-3.49), longer preoperative length of stay (OR, 1.51; 95% CI, 1.43-1.60), Medicare (OR, 1.21; 95% CI, 1.05-1.39) and Medicaid (OR, 1.60; 95% CI, 1.31-1.96) coverage, and more comorbidities were associated with CDI. Among the matched pairs, patients with CDIs had greater mortality (302 [12%] vs 187 [7.2%], P <.001), a longer median length of stay (21 vs 11 days, P <.001), and greater median hospital charges ($193,330 vs $112,245, P <.001). The cumulative incremental cost of CDIs was an estimated $212 million annually.

Conclusions Our results have shown that CDI is associated with increased morbidity and resource usage. Additional work is needed to better understand the complex interplay among regional-, hospital-, and patient-level factors.

Original languageEnglish (US)
Pages (from-to)2404-2409
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume148
Issue number5
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Analysis of Clostridium difficile infections after cardiac surgery: Epidemiologic and economic implications from national data'. Together they form a unique fingerprint.

Cite this