A. N. Kulaylat1, D. B. Stewart1, C. S. Hollenbeak2 1Penn State Hershey Medical Center,Division Of Colon And Rectal Surgery, Department Of Surgery,Hershey, PA, USA 2Penn State Hershey Medical Center,Division Of Outcomes, Research And Quality, Departments Of Surgery And Public Health Sciences,Hershey, PA, USA
Introduction: Clostridium difficile infection (CDI) is the most common nosocomial diarrheal disease in the United States, imposing substantial morbidity to patients. Less is known about the influence of CDI on healthcare resource utilization following surgical or procedure-based interventions. Our aim was to determine the incidence of CDI across a variety of procedures and evaluate the impact of CDI on discharge status, readmission, and length of stay (LOS) among patients in Pennsylvania.
Methods: Data were obtained from the Pennsylvania Health Care Cost Containment Council (PHC4) during 2011. PHC4 collects discharge information for all patients undergoing treatment at general acute care hospitals (excluding VA hospitals). Patients with an ICD-9 procedure code were included (n=580,754), organized by procedure category. The presence of a CDI on discharge diagnosis was abstracted using an ICD-9 diagnosis code of 008.45, and based on this stratification, patient demographics and characteristics were compared with standard univariate statistics. Logistic regression was used to model the impact of CDI on discharge status and readmission, while generalized linear regression was used to model the effects of CDI on LOS.
Results: The overall incidence of CDI across all procedures was 0.58%. The highest rates of CDI were among hematologic/lymphatic (1.3%), gastrointestinal (1.2%), respiratory tract (1.1%), cardiovascular (1.0%), and integument (0.7%) procedures. After controlling for patient demographics, admission type, comorbidities, operation type and postoperative complications (excluding CDI), CDI was associated with an increased odds of requiring additional care on discharge (e.g. skilled nursing or intermediate care facility, visiting nurses, etc.) (OR 3.18, p<0.001), as well as 30-day readmission (OR 1.82, p<0.001). The occurrence of a CDI protracted the LOS by 5.3 days (p<0.0001).
Conclusion: The development of CDI poses a substantial burden to healthcare resource utilization. As the incidence of CDI varies by procedure, targeted efforts to address CDI rates will need to account for various specialties and the spectrum of surgical and procedure-based interventions.
