The Rothman Institute of Orthopedics at Thomas Jefferson Hospital, 925 Chestnut Street, Philadelphia, PA, 19107, USA.
Clin Orthop Relat Res. 2013 Oct;471(10):3178-85. doi: 10.1007/s11999-013-2906-x.
The prevalence of Clostridium difficile colitis is reportedly increasing in surgical patients and can negatively impact their outcome. However, as yet there are no clear estimates of the C difficile infection colitis rate and its consequences among patients undergoing total joint arthroplasty (TJA).
QUESTIONS/PURPOSES: We asked: (1) What is the rate of C difficile colitis in TJA patients? (2) What are the risk factors of C difficile colitis in these patients? And (3) what is the effect of C difficile colitis on length of stay, in-hospital mortality, and estimated total charges?
Using ICD-9-CM diagnosis and procedure codes, we queried the Nationwide Inpatient Sample database for patients undergoing TJA for the years 2002 to 2010. Demographic data, comorbidities, occurrence of C difficile colitis, length of hospital stay, mortality, and hospital charges were extracted. Logistic regression was performed to identify predictors of C difficile colitis and its impact on in-hospital mortality.
The incidence of C difficile remained less than 0.6% during the study period. Revision TJAs (odds ratio=6.9 and 4.4 for hip and knee, respectively) and number of comorbidities (odds ratio=1.5) increased risk of C difficile colitis. C difficile increased length of hospital stay by a week, hospital charges by USD 40,000, and in-hospital mortality to 4.66% from 0.24%.
Using lower and fewer doses of antibiotics in revision TJAs and among patients with many comorbidities may diminish risk of C difficile colitis and its consequent mortality.
Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
据报道，手术患者中艰难梭菌结肠炎的患病率正在增加，并且会对其预后产生负面影响。然而，目前尚无明确的接受全关节置换术（TJA）患者中艰难梭菌感染性结肠炎的发生率及其后果的估计。
问题/目的：我们询问了以下问题：（1）TJA 患者中艰难梭菌结肠炎的发生率是多少？（2）这些患者中艰难梭菌结肠炎的危险因素有哪些？（3）艰难梭菌结肠炎对住院时间、住院死亡率和估计总费用有什么影响？
我们使用 ICD-9-CM 诊断和手术代码，从 2002 年至 2010 年，在美国全国住院患者样本数据库中查询了接受 TJA 的患者。提取了人口统计学数据、合并症、艰难梭菌结肠炎的发生、住院时间、死亡率和住院费用。进行逻辑回归以确定艰难梭菌感染的预测因素及其对住院死亡率的影响。
在研究期间，艰难梭菌的发生率仍低于 0.6％。翻修 TJA（髋关节和膝关节的比值比分别为 6.9 和 4.4）和合并症数量（比值比为 1.5）增加了艰难梭菌结肠炎的风险。艰难梭菌使住院时间延长了一周，住院费用增加了 40000 美元，住院死亡率从 0.24％上升至 4.66％。
在翻修 TJA 和合并症较多的患者中，使用较低剂量和较少剂量的抗生素可能会降低艰难梭菌结肠炎及其随之而来的死亡率的风险。
II 级，预后研究。请参阅《作者说明》以获取完整的证据水平描述。
