Hisham Hussan1,2, Emmanuel Ugbarugba3, Michael T Bailey4, Kyle Porter5, Bradley Needleman6, Sabrena Noria6, Benjamin O'Donnell7, Steven K Clinton8,9. 1. Division of Gastroenterology, Hepatology, & Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Ave, Suite 240, Columbus, OH, 43210, USA. hisham.Hussan@osumc.edu. 2. Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA. hisham.Hussan@osumc.edu. 3. Division of Hospital Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 4. Center for Microbial Pathogenesis, Research Institute at Nationwide Children's Hospital and Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA. 5. Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA. 6. Center for Minimally Invasive Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 7. Division of Endocrine, Diabetes and Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 8. Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA. 9. Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Abstract
BACKGROUND AND AIMS: Clostridium difficile infection (CDI) is major health care concern with reports linking it to obesity. Our aim was to investigate the little known impact of the two most common bariatric surgeries, Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG), on risk of CDI admissions. METHODS: This is a retrospective cohort study using the 2013 Nationwide Readmission Database. We examined inpatient CDI rates within 120 days after RYGB (n = 40,059) and VSG (n = 45,394). In a time to event analysis we also evaluated inpatient CDI rates up to 11 months post-surgery. We chose morbidly obese patients that underwent non-emergent ventral hernia repair (VHR) as additional surgical controls (n = 9673). RESULT: CDI rates were higher after RYGB than VSG in the first 30 days (odds ratio [OR] = 2.10; 95% confidence interval [CI], 1.05-4.20) with a similar but nonsignificant trend within 31-120 days. CDI rates were also higher after RYGB compared to VHR controls within 31-120 days after surgery (OR = 3.22, 95%CI: 1.31, 7.88, p = 0.01). In a time to event analysis with up to 11 months follow up, RYGB led to higher CDI compared to VSG (hazard ratio [HR] = 1.87; 95% CI, 1.12-3.13) with a trend towards higher CDI compared to VHR (HR = 1.95; 95% CI, 0.94-4.06). Similar CDI rates occurred after VSG vs VHR. CONCLUSIONS: RYGB may increase the risk of CDI hospitalization when compared to VSG and VHR controls. This data suggest VSG may be a better bariatric choice when post-surgical CDI risk is a concern.
BACKGROUND AND AIMS: Clostridium difficileinfection (CDI) is major health care concern with reports linking it to obesity. Our aim was to investigate the little known impact of the two most common bariatric surgeries, Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG), on risk of CDI admissions. METHODS: This is a retrospective cohort study using the 2013 Nationwide Readmission Database. We examined inpatient CDI rates within 120 days after RYGB (n = 40,059) and VSG (n = 45,394). In a time to event analysis we also evaluated inpatient CDI rates up to 11 months post-surgery. We chose morbidly obesepatients that underwent non-emergent ventral hernia repair (VHR) as additional surgical controls (n = 9673). RESULT: CDI rates were higher after RYGB than VSG in the first 30 days (odds ratio [OR] = 2.10; 95% confidence interval [CI], 1.05-4.20) with a similar but nonsignificant trend within 31-120 days. CDI rates were also higher after RYGB compared to VHR controls within 31-120 days after surgery (OR = 3.22, 95%CI: 1.31, 7.88, p = 0.01). In a time to event analysis with up to 11 months follow up, RYGB led to higher CDI compared to VSG (hazard ratio [HR] = 1.87; 95% CI, 1.12-3.13) with a trend towards higher CDI compared to VHR (HR = 1.95; 95% CI, 0.94-4.06). Similar CDI rates occurred after VSG vs VHR. CONCLUSIONS: RYGB may increase the risk of CDI hospitalization when compared to VSG and VHR controls. This data suggest VSG may be a better bariatric choice when post-surgical CDI risk is a concern.
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