A. N. Kulaylat1, A. B. Podany1, M. Twilley1, C. S. Hollenbeak1, D. V. Rocourt1, B. W. Engbrecht1, M. C. Santos1, R. E. Cilley1, P. W. Dillon1 1Penn State Hershey Medical Center,Department Of Surgery,Hershey, PA, USA
Introduction: While previous studies have evaluated risk factors for developing Clostridium difficile infection (CDI), less is known about the cost burden imposed by CDI in the hospitalized pediatric surgical population. The purpose of our analysis was to assess the occurrence of CDI across pediatric thoracic and abdominal surgeries, and characterize its influence on the cost of care.
Methods: There were 320,096 children (age 1-18 years) identified undergoing a thoracic or abdominal surgery from the Kids’ Inpatient Database (2003, 2006, 2009, 2012). Patients were stratified based on the development of CDI and compared using univariate statistics. Logistic regression was used to model factors associated with the development of CDI. A propensity score matched analysis was performed to evaluate the influence of CDI on mortality, length of stay (LOS), and costs in similar patient cohorts. Winsorization (1% and 99%) was applied to reduce the influence of extreme outliers. National population weights were used to estimate the excess burden of CDI on these outcomes.
Results: The overall prevalence of CDI in the sampled cohort was 0.31%, with greater rates of CDI present at children’s hospitals (CH) (3.9 per 1000) compared to non-children’s hospitals (NCH) (2.9 per 1000) (p<0.001). Among both hospital types, there were increasing trends in cases of CDI over time (p<0.001). CDI was associated with younger age and increasing comorbidities (p<0.001). Following propensity score matching, the mean excess LOS and costs attributable to CDI were 7.1 days and $16,021 (p<0.001), respectively, with no significant differences observed for mortality. The estimated annual number of children affected by CDI following surgery was 1,485 (including 11 mortalities), resulting in attributable annual costs of approximately $23.8 million (2012 US$) and 10,544 days spent in the hospital.
Conclusion: CDI is a relatively uncommon but costly complication in pediatric thoracic and abdominal surgery, and is more prevalent in CH compared to NCH. Given the increasing trend of CDI among hospitalized surgical patients, there is substantial opportunity for reduction of inpatient burden and associated costs in this potentially preventable nosocomial infection.