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Obesity as protective against, rather than a risk factor for, postoperative Clostridium difficile infection: A nationwide retrospective analysis of 1,426,807 surgical patients

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

DOI

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    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  1. Most of the variation in length of stay in emergency general surgery is not related to clinical factors of patient care

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Emergency Surgery Score Accurately Predicts the Risk of Post-Operative Infection in Emergency General Surgery

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  • Karien Meier
  • Ask T Nordestgaard
  • Ahmed I Eid
  • Napaporn Kongkaewpaisan
  • Jae Moo Lee
  • Manansun Kongwibulwut
  • Kelsey R Han
  • Nikolaos Kokoroskos
  • April E Mendoza
  • Noelle Saillant
  • David R King
  • George C Velmahos
  • Haytham M A Kaafarani
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BACKGROUND: Recent studies suggest that obesity is a risk factor for Clostridium difficile infection, possibly due to disruptions in the intestinal microbiome composition. We hypothesized that body mass index (BMI) is associated with increased incidence of C. difficile infection in surgical patients.

METHODS: In this nationwide retrospective cohort study in 680 American College of Surgeons National Surgical Quality Improvement Program participating sites across the United States, the occurrence of C. difficile infection within 30 days postoperatively between different BMI groups was compared. All American College of Surgeons National Surgical Quality Improvement Program patients between 2015 and 2016 were classified as underweight, normal-weight, overweight, or obese class I-III if their BMI was less than 18.5, 18.5 to 25, 25 to 30, 30 to 35, 35 to 40 or greater than 40, respectively.

RESULTS: A total of 1,426,807 patients were included; median age was 58 years, 43.4% were male, and 82.9% were white. The postoperative incidence of C. difficile infection was 0.42% overall: 1.11%, 0.56%, 0.39%, 0.35%, 0.33% and 0.36% from the lowest to the highest BMI group, respectively (p < 0.001 for trend). In univariate then multivariable logistic regression analyses, adjusting for patient demographics (e.g., age, sex), comorbidities (e.g., diabetes, systemic sepsis, immunosuppression), preoperative laboratory values (e.g., albumin, white blood cell count), procedure complexity (work relative unit as a proxy) and procedure characteristics (e.g., emergency, type of surgery [general, vascular, other]), compared with patients with normal BMI, high BMI was inversely and incrementally correlated with the postoperative occurrence of C. difficile infection. The underweight were at increased risk (odds ratio, 1.15 [1.00-1.32]) while the class III obese were at the lowest risk (odds ratio, 0.73 [0.65-0.81]).

CONCLUSION: In this nationwide retrospective cohort study, obesity is independently and in a stepwise fashion associated with a decreased risk of postoperative C. difficile infection. Further studies are warranted to explore the potential and unexpected association.

LEVEL OF EVIDENCE: Prognostic/Epidemiologic, Level IV.

OriginalsprogEngelsk
TidsskriftThe journal of trauma and acute care surgery
Vol/bind86
Udgave nummer6
Sider (fra-til)1001-1009
Antal sider9
ISSN2163-0755
DOI
StatusUdgivet - jun. 2019

ID: 57805932