General surgery patients who undergo emergency surgery are at greater risk of developing Clostridium difficile infection compared to those who undergo laparoscopic surgery, suggests a recent study from the United States published in the American Journal of Surgery.¹

In this study, researchers included 436,831 patients, mean age 55 years, who had undergone general surgery procedures in the year 2019 from the American College of Surgeons  National Surgical Quality Improvement Program database (NSQIP) database. This database collects morbidity and mortality data for 30 days post-surgery. More than half of the study population was female (56%). Around 40% of the study participants underwent laparoscopic surgery, while 15% operations were emergency procedures.

A total of 1840 patients (0.4%) were found to have developed C. difficile infection. The mortality rate was higher in these patients (2.1%) compared to those who did not have C. difficile infection (0.76%). The presence of C. difficile infection also increased the duration of hospitalization; 7 days vs 1 day, respectively). The likelihood of C. difficile infection was less among patients who underwent a laparoscopic surgery compared to patients who did not undergo laparoscopic surgery (29.9% vs 37.5%, respectively).

Factors that were associated with greater risk of C. difficile infection were also determined on multivariable logistic regression analysis. These included advanced age, smoking, lower body mass index (BMI), prolonged surgery, steroid therapy, superficial and deep organ space infections and metastatic cancer.

1. difficile is a common healthcare associated infection in surgical patients. This study has shown that though rare, general surgery patients are at risk of developing C. difficile infection. Recognition of major risk factors, as determined in this study, will help to identify at-risk patients and facilitate timely implementation of infection control measures.

Reference

1. Hess A, et al. Risk factors for clostridium difficile infection in general surgery patients. Am J Surg. September 21, 2022. DOI: https://doi.org/10.1016/j.amjsurg.2022.09.031.