title: Clostridium difficile colitis in patients undergoing lumbar spine surgery.
abstract: METHODS
  Retrospective database analysis.
  
  
  OBJECTIVE
  To investigate incidence, comorbidities, and impact on health care resources of Clostridium difficile infection after lumbar spine surgery.
  
  
  BACKGROUND
  C. difficile colitis is reportedly increasing in hospitalized patients and can have a negative impact on patient outcomes. No data exist on estimates of C. difficile infection rates and its consequences on patient outcomes and health care resources among patients undergoing lumbar spine surgery.
  
  
  METHODS
  The Nationwide Inpatient Sample was examined from 2002 to 2011. Patients were included for study based on International Classification of Diseases, Ninth Revision, Clinical Modification, procedural codes for lumbar spine surgery for degenerative diagnoses. Baseline patient characteristics were determined and multivariable analyses assessed factors associated with increased incidence of C. difficile and risk of mortality.
  
  
  RESULTS
  The incidence of C. difficile infection in patients undergoing lumbar spine surgery is 0.11%. At baseline, patients infected with C. difficile were significantly older (65.4 yr vs. 58.9 yr, P<0.0001) and more likely to have diabetes with chronic complications, neurological complications, congestive heart failure, pulmonary disorders, coagulopathy, and renal failure. Lumbar fusion (P=0.0001) and lumbar fusion revision (P=0.0003) were associated with increased odds of postoperative infection. Small hospital size was associated with decreased odds (odds ratio [OR], 0.5; P<0.001), whereas urban hospitals were associated with increased odds (OR, 2.14; P<0.14) of acquiring infection. Uninsured (OR, 1.62; P<0.0001) and patients with Medicaid (OR, 1.33; P<0.0001) were associated with higher odds of acquiring postoperative infection. C. difficile increased hospital length of stay by 8 days (P<0.0001), hospital charges by 2-fold (P<0.0001), and inpatient mortality to 4% from 0.11% (P<0.0001).
  
  
  CONCLUSIONS
  C. difficile infection after lumbar spine surgery carries a 36.4-fold increase in mortality and costs approximately $10,658,646 per year to manage. These data suggest that great care should be taken to avoid C. difficile colitis in patients undergoing lumbar spine surgery because it is associated with longer hospital stays, greater overall costs, and increased inpatient mortality.
  
  
  METHODS
  3.
authors: Departments of *Neurosurgery and †Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY; and ‡The Perlman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors: Branko
authors: B
authors: Skovrlj
authors: Javier Z
authors: JZ
authors: Guzman
authors: Jason
authors: J
authors: Silvestre
authors: Motasem
authors: M
authors: Al Maaieh
authors: Sheeraz A
authors: SA
authors: Qureshi
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000191:economics / Q000453:epidemiology*; D003092:Colitis / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology; D015897:Comorbidity; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs; D006742:Hospital Bed Capacity; D017052:Hospital Mortality; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008159:Lumbar Vertebrae / Q000601:surgery*; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology; D012307:Risk Factors; D013122:Spinal Diseases / Q000453:epidemiology / Q000601:surgery; D013123:Spinal Fusion / Q000706:statistics & numerical data; D014481:United States