Risk Factors and Costs Associated With Clostridium difficile Colitis in Patients With Prosthetic Joint Infection Undergoing Revision Total Hip Arthroplasty
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Published on: December 3, 2017
Ronald E Delanois1, Nicole E George1, Jennifer I Etcheson1
1Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
Insights
Clostridium difficile colitis is uncommon after revision hip arthroplasty but leads to longer hospital stays, higher costs, and increased mortality. Understanding risk factors is crucial for managing this complication.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Epidemiology
- Health Services Research
Background:
- Rising rates of primary total hip arthroplasty (THA) and revision procedures necessitate understanding Clostridium difficile colitis risks.
- Identifying factors associated with C. difficile colitis post-revision THA is critical for patient outcomes.
Purpose of the Study:
- To analyze the incidence, demographics, costs, and mortality associated with C. difficile colitis following revision THA.
- To identify risk factors for developing C. difficile colitis after revision THA.
Main Methods:
- Utilized the National Inpatient Sample database (2009-2013) for revision THA patients (n=40,876).
- Identified patients who developed C. difficile colitis during their inpatient stay.
- Employed multilevel logistic regression to assess contributing factors.
Main Results:
- The incidence of C. difficile colitis post-revision THA was 1.7%.
- Affected patients were older, had longer hospital stays, incurred higher costs, and experienced greater in-hospital mortality.
- Colitis patients had a 5.6% in-hospital mortality rate versus 1.4% for non-colitis patients.
Conclusions:
- C. difficile colitis is an infrequent but serious complication of revision THA.
- This infection is linked to significantly increased hospital length of stay, healthcare costs, and mortality risk.
Background:
With the increased demand for primary total hip arthroplasty (THA) and corresponding rise in revision procedures, it is imperative to understand the factors contributing to the development of Clostridium difficile colitis. We aimed to provide a detailed analysis of: (1) the incidence of; (2) the demographics, lengths of stay, and total costs for; and (3) the risk factors and mortality associated with the development of C. difficile colitis after revision THA.
Methods:
The National Inpatient Sample database was queried for all individuals diagnosed with a periprosthetic joint infection and who underwent all-component revision THA between 2009 and 2013 (n = 40,876). Patients who developed C. difficile colitis during their inpatient hospital stay were identified. Multilevel logistic regression analysis was conducted to assess the association between hospital- and patient-specific characteristics and the development of C. difficile colitis.
Results:
The overall incidence of C. difficile colitis after revision THA was 1.7%. These patients were significantly older (74 vs 65 years), had greater lengths of hospital stay (19 vs 9 days), accumulated greater costs ($51,641 vs $28,282), and were more often treated in an urban hospital compared to their counterparts who did not develop C. difficile colitis (P < .001 for all). Patients with colitis also had a significantly higher in-hospital mortality compared to those without (5.6% vs 1.4%; P < .001).
Conclusion:
While C. difficile colitis infection is an uncommon event following revision THA, it can have potentially devastating consequences. Our analysis demonstrates that this infection is associated with a longer hospital stay, higher costs, and greater in-hospital mortality.
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