Clostridium difficile and Laparoscopic Bariatric Surgery: an Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Database.

BACKGROUND

Obesity is associated with disturbances in the gut microbiota which is a risk factor for Clostridium difficile infection (CDI). Bariatric surgery can induce substantive changes to the gut microbiota which may affect the risk of developing CDI.

METHODS

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program captures variables specific to bariatric surgery from 832 centers. Patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) in 2016 and 2017 were identified. Primary outcomes included the prevalence and predictors of CDI after bariatric surgery. A multivariable logistic regression model determined preoperative factors predictive of 30-day CDI.

RESULTS

A total of 78,222 LRYGB and 222,968 LSG were included. The overall incidence of CDI was low with 0.13% developing CDI. Rates of CDI were two times higher after LRYGB compared to LSG (0.2 vs 0.1%, p < 0.001). Although CDI rates were low, CDI was associated with increased post-operative complications. Multivariable analysis identified chronic kidney disease (OR 2.37, 95%CI 1.09-5.15, p = 0.03) and history of venous thromboembolism (OR 2.06, 95%CI 1.29-3.29, p = 0.002) as being most predictive of developing CDI with more than a twofold increase in risk. Patients undergoing LRYGB had an increased risk of CDI compared to LSG (OR 1.65, 95%CI 1.31-2.09, p < 0.001). White race, female sex, and obstructive sleep apnea also increased risk of CDI.

CONCLUSIONS

The incidence of CDI following bariatric surgery is relatively low with LRYGB having a higher risk than LSG. Furthermore, CDI is associated with significant adverse outcomes post-operatively but had no increased risk of mortality.