Clostridium difficile colitis in patients undergoing lower-extremity arthroplasty: rare infection with major impact.

BACKGROUND

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?

METHODS

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.

RESULTS

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%.

CONCLUSIONS

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 OF EVIDENCE

Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.