Incidence, Predictors, and Impact of Clostridium difficile Infection on Cardiac Surgery Outcomes

Background CDI has been associated with morbidity and mortality after cardiac operations. The present study examined incidence, predictors, and impact of CDI on inpatient mortality and resource utilization. Methods An analysis of adult patients undergoing elective coronary artery bypass grafting (CABG) or valvular operations from 2005 to 2016 was performed using the National Inpatient Sample (NIS). Trends in CDI were assessed using a modified Cochran-Armitage analysis. Multivariable multi-level regressions were utilized to identify predictors of CDI and propensity-matched pairs were generated using Mahalanobis 1-to-1 matching to compare mortality, Length of Stay (LOS), and costs of CDI patients with the non- CDI cohort. Results The overall rate of CDI for an estimated 2,026,267 patients who underwent elective major cardiac surgery, was 0.5% with no change in incidence (P-for-trend=0.99). Predictors of CDI included advanced age (AGE≥65: AOR 1.88, 95%CI 1.58-2.24), female gender (AOR 1.29, 95%CI 1.15-1.44), heart failure (AOR 1.57, 95% CI 1.40-1.76) and combined CABG/valve operations (AOR 1.60, 95% CI 1.24-2.08). Neither region nor bedsize were associated with CDI. In contrast, CDI mortality was lower at teaching hospitals compared to rural. Among the matched pairs, CDI was independently associated with higher mortality, LOS and GDP-adjusted costs. Conclusions CDI occurs in less than 1% of all elective, major cardiac operations. Patient predictors included advanced age, female gender, and several chronic comorbidities. Teaching institutions had the highest odds of CDI but lowest odds of case fatality. Further investigation of factors contributing to CDI is warranted to disseminate institutional best practices.