STUDY DESIGN: Retrospective database analysis. OBJECTIVE: To investigate incidence, comorbidities, and impact on health care resources of Clostridium difficile infection after lumbar spine surgery. SUMMARY OF BACKGROUND DATA: C. difficile colitis is reportedly increasing in hospitalized patients and can have a negative impact on patient outcomes. No data exist on estimates of C. difficile infection rates and its consequences on patient outcomes and health care resources among patients undergoing lumbar spine surgery. METHODS: The Nationwide Inpatient Sample was examined from 2002 to 2011. Patients were included for study based on International Classification of Diseases, Ninth Revision, Clinical Modification, procedural codes for lumbar spine surgery for degenerative diagnoses. Baseline patient characteristics were determined and multivariable analyses assessed factors associated with increased incidence of C. difficile and risk of mortality. RESULTS: The incidence of C. difficile infection in patients undergoing lumbar spine surgery is 0.11%. At baseline, patients infected with C. difficile were significantly older (65.4 yr vs. 58.9 yr, P<0.0001) and more likely to have diabetes with chronic complications, neurological complications, congestive heart failure, pulmonary disorders, coagulopathy, and renal failure. Lumbar fusion (P=0.0001) and lumbar fusion revision (P=0.0003) were associated with increased odds of postoperative infection. Small hospital size was associated with decreased odds (odds ratio [OR], 0.5; P<0.001), whereas urban hospitals were associated with increased odds (OR, 2.14; P<0.14) of acquiring infection. Uninsured (OR, 1.62; P<0.0001) and patients with Medicaid (OR, 1.33; P<0.0001) were associated with higher odds of acquiring postoperative infection. C. difficile increased hospital length of stay by 8 days (P<0.0001), hospital charges by 2-fold (P<0.0001), and inpatient mortality to 4% from 0.11% (P<0.0001). CONCLUSION: C. difficile infection after lumbar spine surgery carries a 36.4-fold increase in mortality and costs approximately $10,658,646 per year to manage. These data suggest that great care should be taken to avoid C. difficile colitis in patients undergoing lumbar spine surgery because it is associated with longer hospital stays, greater overall costs, and increased inpatient mortality. LEVEL OF EVIDENCE: 3.
STUDY DESIGN: Retrospective database analysis. OBJECTIVE: To investigate incidence, comorbidities, and impact on health care resources of Clostridium difficileinfection after lumbar spine surgery. SUMMARY OF BACKGROUND DATA: C. difficilecolitis is reportedly increasing in hospitalized patients and can have a negative impact on patient outcomes. No data exist on estimates of C. difficileinfection rates and its consequences on patient outcomes and health care resources among patients undergoing lumbar spine surgery. METHODS: The Nationwide Inpatient Sample was examined from 2002 to 2011. Patients were included for study based on International Classification of Diseases, Ninth Revision, Clinical Modification, procedural codes for lumbar spine surgery for degenerative diagnoses. Baseline patient characteristics were determined and multivariable analyses assessed factors associated with increased incidence of C. difficile and risk of mortality. RESULTS: The incidence of C. difficileinfection in patients undergoing lumbar spine surgery is 0.11%. At baseline, patients infected with C. difficile were significantly older (65.4 yr vs. 58.9 yr, P<0.0001) and more likely to have diabetes with chronic complications, neurological complications, congestive heart failure, pulmonary disorders, coagulopathy, and renal failure. Lumbar fusion (P=0.0001) and lumbar fusion revision (P=0.0003) were associated with increased odds of postoperative infection. Small hospital size was associated with decreased odds (odds ratio [OR], 0.5; P<0.001), whereas urban hospitals were associated with increased odds (OR, 2.14; P<0.14) of acquiring infection. Uninsured (OR, 1.62; P<0.0001) and patients with Medicaid (OR, 1.33; P<0.0001) were associated with higher odds of acquiring postoperative infection. C. difficile increased hospital length of stay by 8 days (P<0.0001), hospital charges by 2-fold (P<0.0001), and inpatient mortality to 4% from 0.11% (P<0.0001). CONCLUSION:C. difficileinfection after lumbar spine surgery carries a 36.4-fold increase in mortality and costs approximately $10,658,646 per year to manage. These data suggest that great care should be taken to avoid C. difficilecolitis in patients undergoing lumbar spine surgery because it is associated with longer hospital stays, greater overall costs, and increased inpatient mortality. LEVEL OF EVIDENCE: 3.
Authors: Patawut Bovonratwet; Daniel D Bohl; Glenn S Russo; Nathaniel T Ondeck; Denis Nam; Craig J Della Valle; Jonathan N Grauer Journal: Clin Orthop Relat Res Date: 2018-03 Impact factor: 4.176
Authors: Massimo Sartelli; Mark A Malangoni; Fikri M Abu-Zidan; Ewen A Griffiths; Stefano Di Bella; Lynne V McFarland; Ian Eltringham; Vishal G Shelat; George C Velmahos; Ciarán P Kelly; Sahil Khanna; Zaid M Abdelsattar; Layan Alrahmani; Luca Ansaloni; Goran Augustin; Miklosh Bala; Frédéric Barbut; Offir Ben-Ishay; Aneel Bhangu; Walter L Biffl; Stephen M Brecher; Adrián Camacho-Ortiz; Miguel A Caínzos; Laura A Canterbury; Fausto Catena; Shirley Chan; Jill R Cherry-Bukowiec; Jesse Clanton; Federico Coccolini; Maria Elena Cocuz; Raul Coimbra; Charles H Cook; Yunfeng Cui; Jacek Czepiel; Koray Das; Zaza Demetrashvili; Isidoro Di Carlo; Salomone Di Saverio; Irina Magdalena Dumitru; Catherine Eckert; Christian Eckmann; Edward H Eiland; Mushira Abdulaziz Enani; Mario Faro; Paula Ferrada; Joseph Derek Forrester; Gustavo P Fraga; Jean Louis Frossard; Rita Galeiras; Wagih Ghnnam; Carlos Augusto Gomes; Venkata Gorrepati; Mohamed Hassan Ahmed; Torsten Herzog; Felicia Humphrey; Jae Il Kim; Arda Isik; Rao Ivatury; Yeong Yeh Lee; Paul Juang; Luis Furuya-Kanamori; Aleksandar Karamarkovic; Peter K Kim; Yoram Kluger; Wen Chien Ko; Francis D LaBarbera; Jae Gil Lee; Ari Leppaniemi; Varut Lohsiriwat; Sanjay Marwah; John E Mazuski; Gokhan Metan; Ernest E Moore; Frederick Alan Moore; Carl Erik Nord; Carlos A Ordoñez; Gerson Alves Pereira Júnior; Nicola Petrosillo; Francisco Portela; Basant K Puri; Arnab Ray; Mansoor Raza; Miran Rems; Boris E Sakakushev; Gabriele Sganga; Patrizia Spigaglia; David B Stewart; Pierre Tattevin; Jean Francois Timsit; Kathleen B To; Cristian Tranà; Waldemar Uhl; Libor Urbánek; Harry van Goor; Angela Vassallo; Jean Ralph Zahar; Emanuele Caproli; Pierluigi Viale Journal: World J Emerg Surg Date: 2015-08-20 Impact factor: 5.469
Authors: Massimo Sartelli; Stefano Di Bella; Lynne V McFarland; Sahil Khanna; Luis Furuya-Kanamori; Nadir Abuzeid; Fikri M Abu-Zidan; Luca Ansaloni; Goran Augustin; Miklosh Bala; Offir Ben-Ishay; Walter L Biffl; Stephen M Brecher; Adrián Camacho-Ortiz; Miguel A Caínzos; Shirley Chan; Jill R Cherry-Bukowiec; Jesse Clanton; Federico Coccolini; Maria E Cocuz; Raul Coimbra; Francesco Cortese; Yunfeng Cui; Jacek Czepiel; Zaza Demetrashvili; Isidoro Di Carlo; Salomone Di Saverio; Irina M Dumitru; Christian Eckmann; Edward H Eiland; Joseph D Forrester; Gustavo P Fraga; Jean L Frossard; Donald E Fry; Rita Galeiras; Wagih Ghnnam; Carlos A Gomes; Ewen A Griffiths; Xavier Guirao; Mohamed H Ahmed; Torsten Herzog; Jae Il Kim; Tariq Iqbal; Arda Isik; Kamal M F Itani; Francesco M Labricciosa; Yeong Y Lee; Paul Juang; Aleksandar Karamarkovic; Peter K Kim; Yoram Kluger; Ari Leppaniemi; Varut Lohsiriwat; Gustavo M Machain; Sanjay Marwah; John E Mazuski; Gokhan Metan; Ernest E Moore; Frederick A Moore; Carlos A Ordoñez; Leonardo Pagani; Nicola Petrosillo; Francisco Portela; Kemal Rasa; Miran Rems; Boris E Sakakushev; Helmut Segovia-Lohse; Gabriele Sganga; Vishal G Shelat; Patrizia Spigaglia; Pierre Tattevin; Cristian Tranà; Libor Urbánek; Jan Ulrych; Pierluigi Viale; Gian L Baiocchi; Fausto Catena Journal: World J Emerg Surg Date: 2019-02-28 Impact factor: 5.469
Authors: Javier Z Guzman; Branko Skovrlj; Edward S Rothenberg; Young Lu; Steven McAnany; Samuel K Cho; Andrew C Hecht; Sheeraz A Qureshi Journal: Global Spine J Date: 2015-08-10