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Outcomes of clostridioides difficile infection on inflammatory bowel disease patients undergoing colonic resection: A propensity score weighted NSQIP analysis

Published:November 01, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.10.061

      Highlights

      • Inflammatory bowel disease (IBD) patients are at risk for c. difficile infection (CDI).
      • We analyzed IBD colectomy patients with and without CDI in the ACS NSQIP PUF.
      • 119 (0.93%) of 12,782 IBD patients were diagnosed with CDI within 30 days of surgery.
      • After propensity score weighting, IBD-CDI was associated with increased complications.
      • Mean LOS was increased by 39% in patients with CDI (OR 1.39 95% CI [1.19–1.64]).

      Abstract

      Background

      Inflammatory bowel disease (IBD) patients are at risk for Clostridioides difficile infection (CDI). The majority of published outcomes data feature medically treated patients. We aimed to analyze outcomes in a large cohort of surgical IBD patients diagnosed with CDI.

      Methods

      All patients with IBD in the ACS NSQIP Colectomy and Proctectomy (2015–2019) modules were identified. The IBD-CDI and IBD cohorts were propensity score weighted on demographic and surgical factors and compared.

      Results

      In the entire unmatched cohort (n = 12,782), 119/0.93% patients were diagnosed with CDI (74.2% Crohn's/25.7% UC/Indeterminate colitis) within 30-days of surgery. After propensity score weighting, IBD-CDI was associated with increased risk of readmission (OR 4.55 [3.09–6.71], p < 0.001), reoperation (3.17 [1.81–5.52], p < 0.001) and any complication (2.16 [1.47–3.17], p < 0.001). Any SSI (2.58 [1.67–3.98]), organ space SSI (2.49 [1.51–4.11], both p < 0.001), prolonged ventilation (4.03 [1.39–11.69],p = 0.01), acute renal failure (15.06 [4.26–53.26],p < 0.001), stroke (12.36 [1.26–121.06],p = 0.03), sepsis (2.4 [1.39–4.15],p = 0.002) and septic shock (3.29 [1.36–7.96],p = 0.008) were also higher in the IBD-CDI cohort. Mean length of stay was increased by 39% in CDI patients.

      Conclusion

      Post colonic resection, IBD-CDI patients have worse outcomes than IBD patients without CDI. These patients represent a particularly vulnerable cohort who require close monitoring for the development of postoperative complications.
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