Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Spine (Phila Pa 1976). 2018 Jun 15;43(12):861-868. doi: 10.1097/BRS.0000000000002430.
A retrospective study of prospectively collected data.
The aim of this study was to utilize a large national database with post-hospitalization follow-up data [National Surgical Quality Improvement Program (NSQIP)] to determine the incidence, risk factors, timing, and clinical impact of Clostridium difficile colitis in spine surgery patients.
Recent literature has suggested an increased incidence of C. difficile infections. However, there has been a lack of large cohort studies defining the incidence and impact of C. difficile colitis in patients undergoing spine surgery.
Patients who underwent spine surgical procedures in the 2015 NSQIP database were identified. The primary outcome was a diagnosis of C. difficile colitis within the 30-day postoperative period. Independent risk factors for development of C. difficile colitis were identified using multivariate regression. Postoperative length of stay and rate of 30-day readmission were compared between patients who did and did not develop C. difficile colitis.
A total of 23,981 patients who underwent spine surgical procedures were identified. The incidence of C. difficile colitis was approximately 0.11% [95% confidence interval (95% CI), 0.07-0.16]. Of the cases that developed C. difficile colitis, 70% were diagnosed postdischarge and 88% had not had a pre-existing infection diagnosed. Independent risk factors for the development of C. difficile colitis were combined anterior/posterior lumbar fusion procedures [odds ratio (OR) = 12.29, 95% CI = 2.22-68.13, P = 0.010], greater age (most notably ≥76 years old, OR = 10.31, 95% CI = 3.06-34.76, P < 0.001), hypoalbuminemia (OR = 6.40, 95% CI = 2.49-16.43, P < 0.001), and anemia (OR = 2.39, 95% CI = 1.13-5.05, P = 0.023). The development of C. difficile colitis was associated with greater length of stay (2.2 vs. 12.5 days; P < 0.001) and increased 30-day readmission (OR = 8.21, 95% CI = 3.14-21.45, P < 0.001).
C. difficile was diagnosed in 0.11% of patients undergoing spine surgery. The majority of these cases occurred after discharge and in patients not having prior infection diagnoses. High-risk patients should be monitored and targeted with preventative interventions accordingly.
前瞻性收集数据的回顾性研究。
本研究旨在利用具有住院后随访数据的大型国家数据库[国家外科质量改进计划（NSQIP）]，确定艰难梭菌结肠炎在脊柱手术患者中的发生率、危险因素、时间和临床影响。
最近的文献表明艰难梭菌感染的发生率有所增加。然而，缺乏大型队列研究来定义接受脊柱手术患者中艰难梭菌结肠炎的发生率和影响。
确定 2015 年 NSQIP 数据库中接受脊柱手术的患者。主要结局是在术后 30 天内诊断出艰难梭菌结肠炎。使用多变量回归确定艰难梭菌结肠炎发展的独立危险因素。比较发生和未发生艰难梭菌结肠炎的患者的术后住院时间和 30 天再入院率。
共确定了 23981 例接受脊柱手术的患者。艰难梭菌结肠炎的发生率约为 0.11%[95%置信区间（95%CI），0.07-0.16]。发生艰难梭菌结肠炎的病例中，70%在出院后诊断，88%没有诊断出先前存在的感染。艰难梭菌结肠炎发展的独立危险因素是前后腰椎融合术[比值比（OR）=12.29，95%CI=2.22-68.13，P=0.010]、年龄较大（尤其是≥76 岁，OR=10.31，95%CI=3.06-34.76，P<0.001）、低白蛋白血症（OR=6.40，95%CI=2.49-16.43，P<0.001）和贫血（OR=2.39，95%CI=1.13-5.05，P=0.023）。艰难梭菌结肠炎的发生与较长的住院时间（2.2 天与 12.5 天；P<0.001）和 30 天再入院率增加（OR=8.21，95%CI=3.14-21.45，P<0.001）相关。
在接受脊柱手术的患者中，艰难梭菌的诊断率为 0.11%。这些病例大多数发生在出院后，并且在没有先前感染诊断的患者中。高危患者应进行监测，并相应地进行预防性干预。
3 级。
