Clostridium Difficile Associated Infection in the Plastic Surgery Population: Lessons Learned from the ACS NSQIP Database
Efstathios Karamanos, MD1, Howard Wang, MD1, Scott J. Farber, MD1, David Sahar, MD2, Amita Shah, MD, PhD1.
1University of Texas in San Antonio, San Antonio, TX, USA, 2University of California, Davis, Sacramento, CA, USA.
PURPOSE: Clostridium Difficile Associated Infection (CDAI) has recently been in the spotlight for all medical and surgical specialties due to its significant added impact on morbidity and mortality of hospitalized patients. CDAI has not only become a reportable quality measure but also often dictates compensation and insurance coverage. There is a paucity of data regarding the incidence, impact and modifiable risk factors in the plastic surgery population.
METHODS: The ACS NSQIP database was retrospectively queried for all cases performed by plastic surgeons during 2016. The different type of cases, the presence of a second surgical team (combined cases), demographics and baseline clinical characteristics were extracted from the database. The study population was divided in two groups based on the development of CDAI. Independent variables for development of CDAI were identified.
RESULTS: During the study period, a total of 29,256 patients underwent a procedure by a plastic surgeon. Out of those, only 44 developed post - operatively CDAI (0.1%). The most commonly performed procedures involved the breast (58%) followed by the trunk (14%). Factors independently associated with development of CDAI were wound classification at the end of the surgery, COPD, procedure involving the trunk and surgery for reconstruction of pressure ulcers. Outpatient surgery was associated with decreased odds of developing CDAI [AORs (95% CI):0.2 (0.1, 0.4), adj p < 0.001]. Staying overnight did not increase the odds of developing CDAI, however, staying for > 1 day in the hospital was associated with increased risk of CDAI development [AOR (95% CI): 1.03 (1.01, 1.13), adj p = 0.001]. Combined cases, ASA, BMI, diabetes and active smoking were not associated with CDAI.
CONCLUSION: Clostridium Difficile Associated Infections (CDAI) is exceedingly rare in the plastic surgery population. While combined cases were not a risk factor for this population, outpatient status had a protective effect on CDAI development. Overnight stay after elective surgery did not increased the odds of CDAI, however the longer the hospital stay, the higher the odds of developing CDAI. Enhanced recovery protocols allowing for a shorter hospitalization after pressure ulcer reconstruction may decrease the incidence of CDAI.
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