title: Clostridium difficile infection after colorectal surgery: a rare but costly complication.
abstract: BACKGROUND
  The incidence and virulence of Clostridium difficile infection (CDI) are on the rise. The characteristics of patients who develop CDI following colorectal resection have been infrequently studied.
  
  
  METHODS
  We utilized the University HealthSystem Consortium database to identify adult patients undergoing colorectal surgery between 2008 and 2012. We examined the patient-related risk factors for CDI and 30-day outcomes related to its occurrence.
  
  
  RESULTS
  A total of 84,648 patients met our inclusion criteria, of which the average age was 60 years and 50% were female. CDI occurred in 1,266 (1.5%) patients during the years under study. The strongest predictors of CDI were emergent procedure, inflammatory bowel disease (IBD), and major/extreme APR-DRG severity of illness score. CDI was associated with a higher rate of complications, intensive care unit (ICU) admission, longer preoperative inpatient stay, 30-day readmission rate, and death within 30 days compared to non-CDI patients. Cost of the index stay was, on average, $14,130 higher for CDI patients compared with non-CDI patients.
  
  
  CONCLUSIONS
  Emergent procedures, higher severity of illness, and inflammatory bowel disease are significant risk factors for postoperative CDI in patients undergoing colorectal surgery. Once established, CDI is associated with worse outcomes and higher costs. The poor outcomes of these patients and increased costs highlight the importance of prevention strategies targeting high-risk patients.
authors.affiliation: Department of Surgery, University of Massachusetts Medical Center, 55 Lake Ave Room S3-752, Worcester, MA, 01655, USA, rachelledamle@gmail.com.
authors.forename: Rachelle N
authors.initials: RN
authors.lastname: Damle
authors.forename: Nicole B
authors.initials: NB
authors.lastname: Cherng
authors.forename: Julie M
authors.initials: JM
authors.lastname: Flahive
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Davids
authors.forename: Justin A
authors.initials: JA
authors.lastname: Maykel
authors.forename: Paul R
authors.initials: PR
authors.lastname: Sturrock
authors.forename: W Brian
authors.initials: WB
authors.lastname: Sweeney
authors.forename: Karim
authors.initials: K
authors.lastname: Alavi
mesh_terms: D000293:Adolescent; D000328:Adult; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003107:Colorectal Surgery / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D004761:Enterocolitis, Pseudomembranous / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
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