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The Impact of Bariatric Surgery on Short Term Risk of Clostridium Difficile Admissions

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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.

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Abbreviations

AHA:

Americans Heart Association

AHRQ:

Agency for Healthcare Research and Quality

CDI:

Clostridium Difficile infection

CI:

Confidence Interval

HCUP:

Healthcare Cost and Utilization Project

HR:

Hazard ratio

ICD-9-CM:

International Classification of Diseases, Ninth Revision, Clinical Modification

LOS:

Length of hospital stay

NRD:

Nationwide Readmission Database

OR:

Odds ratio

PPI:

Proton pump inhibitors

RYGB:

Roux-en-Y Gastric Bypass

SID:

State Inpatient Databases

VHR:

Ventral Hernia Repair

VSG:

Vertical Sleeve Gastrectomy

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Author information

Authors and Affiliations

  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

  2. Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA

    Hisham Hussan & Steven K. Clinton

  3. Division of Hospital Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Emmanuel Ugbarugba

  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

    Michael T. Bailey

  5. Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA

    Kyle Porter

  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

    Bradley Needleman & Sabrena Noria

  7. Division of Endocrine, Diabetes and Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Benjamin O’Donnell

  8. Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Steven K. Clinton

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  1. Hisham Hussan
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  2. Emmanuel Ugbarugba
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  6. Sabrena Noria
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  7. Benjamin O’Donnell
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Contributions

Dr. Hussan was involved in conception, design, interpretation of data and the drafting and critical revision of the manuscript. Mr. Kyle Porter was involved in study design, performed the acquisition and the statistical analysis of the data and provided critical revision of the manuscript. The above authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Ugbarugba collected the institutional data and was involved in design, interpretation of data and critical revision of the manuscript. Drs. Bailey, Needleman, Noria, O’Donnell and Clinton were involved in design, interpretation of data and critical revision of the manuscript. All gave final approval of the submitted manuscript and take responsibility for the integrity of the work.

Corresponding author

Correspondence to Hisham Hussan.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Informed Consent

NRD database is comprised of de-identified patient information and does not meet the criteria for human subject and as such did not need institutional Review Board (IRB) approval nor require any form of consenting process prior to analysis of the data. Our supplemental tertiary center analysis was a de-identified retrospective chart review that contained no identifiable information and required no informed consent. Thus, no identifying information is available in the article and no informed consent was obtained.

Statement of Human and Animal Right

For this type of study formal consent is not required.

Additional information

AWARD:

This research was presented as an oral at the American College of Gastroenterology (ACG) 2016 National Meeting and awarded the 2016 ACG Obesity Award for Best Scientific Paper.

Grant Support:

No financial support was utilized in the creation of this project.

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Hussan, H., Ugbarugba, E., Bailey, M.T. et al. The Impact of Bariatric Surgery on Short Term Risk of Clostridium Difficile Admissions. OBES SURG 28, 2006–2013 (2018). https://doi.org/10.1007/s11695-018-3131-1

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