title: Costs of Clostridium difficile infection in pediatric operations: A propensity score-matching analysis.
abstract: The purpose of this analysis was to assess the burden of Clostridium difficile infection in the hospitalized pediatric surgical population and to characterize its influence on the costs of care.
  
  
  
  There were 313,664 patients age 1-18 years who underwent a general thoracic or abdominal procedure in the Kids' Inpatient Database during 2003, 2006, 2009, and 2012. Logistic regression was used to model factors associated with the development of C difficile infection. A propensity score-matching analysis was performed to evaluate the influence of C difficile infection on mortality, duration of stay, and costs in similar patient cohorts. Population weights were used to estimate the national excess burden of C difficile infection on these outcomes.
  
  
  
  The overall prevalence of C difficile infection in the sampled cohort was 0.30%, with an increasing trend of C difficile infection over time in non-children's hospitals (P < .001). C difficile infection was associated with younger age, nonelective procedures, increasing comorbidities, and urban teaching hospital status (P < .001). An estimated 1,438 children developed C difficile infection after operation. After propensity score matching, the mean excess duration of stay and costs attributable to C difficile infection were 5.8 days and $12,801 (P < .001), accounting for 8,295 days spent in the hospital and $18.4 million (2012 USD) in spending annually.
  
  
  
  C difficile infection is a relatively uncommon but costly complication after pediatric operative procedures. Given the increasing trend of C difficile infection among hospitalized surgical patients, there is substantial opportunity for reduction of inpatient burden and associated costs in this potentially preventable nosocomial infection.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA. Electronic address: akulaylat@hmc.psu.edu.
authors.forename: Afif N
authors.initials: AN
authors.lastname: Kulaylat
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA.
authors.forename: Dorothy V
authors.initials: DV
authors.lastname: Rocourt
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA.
authors.forename: Abigail B
authors.initials: AB
authors.lastname: Podany
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA.
authors.forename: Brett W
authors.initials: BW
authors.lastname: Engbrecht
authors.affiliation: The Pennsylvania State University, College of Medicine, Hershey, PA.
authors.forename: Marianne
authors.initials: M
authors.lastname: Twilley
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Santos
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Cilley
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Dillon
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D003428:Cross Infection / Q000191:economics* / Q000382:microbiology* / Q000628:therapy; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D057216:Propensity Score; D012189:Retrospective Studies