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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

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Harvard

Meier, K, Nordestgaard, AT, Eid, AI, Kongkaewpaisan, N, Lee, JM, Kongwibulwut, M, Han, KR, Kokoroskos, N, Mendoza, AE, Saillant, N, King, DR, Velmahos, GC & Kaafarani, HMA 2019, 'Obesity as protective against, rather than a risk factor for, postoperative Clostridium difficile infection: A nationwide retrospective analysis of 1,426,807 surgical patients', The journal of trauma and acute care surgery, bind 86, nr. 6, s. 1001-1009. https://doi.org/10.1097/TA.0000000000002249

APA

Meier, K., Nordestgaard, A. T., Eid, A. I., Kongkaewpaisan, N., Lee, J. M., Kongwibulwut, M., Han, K. R., Kokoroskos, N., Mendoza, A. E., Saillant, N., King, D. R., Velmahos, G. C., & Kaafarani, H. M. A. (2019). Obesity as protective against, rather than a risk factor for, postoperative Clostridium difficile infection: A nationwide retrospective analysis of 1,426,807 surgical patients. The journal of trauma and acute care surgery, 86(6), 1001-1009. https://doi.org/10.1097/TA.0000000000002249

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MLA

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Author

Meier, Karien ; Nordestgaard, Ask T ; Eid, Ahmed I ; Kongkaewpaisan, Napaporn ; Lee, Jae Moo ; Kongwibulwut, Manansun ; Han, Kelsey R ; Kokoroskos, Nikolaos ; Mendoza, April E ; Saillant, Noelle ; King, David R ; Velmahos, George C ; Kaafarani, Haytham M A. / Obesity as protective against, rather than a risk factor for, postoperative Clostridium difficile infection : A nationwide retrospective analysis of 1,426,807 surgical patients. I: The journal of trauma and acute care surgery. 2019 ; Bind 86, Nr. 6. s. 1001-1009.

Bibtex

@article{0adbd4cfdb4f4878a93743f23ef894d4,
title = "Obesity as protective against, rather than a risk factor for, postoperative Clostridium difficile infection: A nationwide retrospective analysis of 1,426,807 surgical patients",
abstract = "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.",
keywords = "ACS NSQIP, Clostridium difficile infection, Obesity",
author = "Karien Meier and Nordestgaard, {Ask T} and Eid, {Ahmed I} and Napaporn Kongkaewpaisan and Lee, {Jae Moo} and Manansun Kongwibulwut and Han, {Kelsey R} and Nikolaos Kokoroskos and Mendoza, {April E} and Noelle Saillant and King, {David R} and Velmahos, {George C} and Kaafarani, {Haytham M A}",
year = "2019",
month = jun,
doi = "10.1097/TA.0000000000002249",
language = "English",
volume = "86",
pages = "1001--1009",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams & Wilkins",
number = "6",

}

RIS

TY - JOUR

T1 - Obesity as protective against, rather than a risk factor for, postoperative Clostridium difficile infection

T2 - A nationwide retrospective analysis of 1,426,807 surgical patients

AU - Meier, Karien

AU - Nordestgaard, Ask T

AU - Eid, Ahmed I

AU - Kongkaewpaisan, Napaporn

AU - Lee, Jae Moo

AU - Kongwibulwut, Manansun

AU - Han, Kelsey R

AU - Kokoroskos, Nikolaos

AU - Mendoza, April E

AU - Saillant, Noelle

AU - King, David R

AU - Velmahos, George C

AU - Kaafarani, Haytham M A

PY - 2019/6

Y1 - 2019/6

N2 - 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.

AB - 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.

KW - ACS NSQIP

KW - Clostridium difficile infection

KW - Obesity

UR - http://www.scopus.com/inward/record.url?scp=85066610130&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000002249

DO - 10.1097/TA.0000000000002249

M3 - Journal article

C2 - 31124898

VL - 86

SP - 1001

EP - 1009

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 6

ER -

ID: 57805932