Costs of Clostridium difficile infection in pediatric operations: A propensity score–matching analysis

• Published in: Surgery Vol. 161; no. 5; pp. 1376 - 1386
• Main Authors: Kulaylat, Afif N., MD, MSc, Rocourt, Dorothy V., MD, Podany, Abigail B., MD, Engbrecht, Brett W., MD, MPH, Twilley, Marianne, BS, Santos, Mary C., MD, MEd, Cilley, Robert E., MD, Hollenbeak, Christopher S., PhD, Dillon, Peter W., MD, MSc
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2017
• Subjects: Adolescent; Child; Child, Preschool; Clostridium difficile; Clostridium Infections - economics; Clostridium Infections - epidemiology; Clostridium Infections - therapy; Cross Infection - economics; Cross Infection - microbiology; Cross Infection - therapy; Female; Health Care Costs; Humans; Infant; Infant, Newborn; Logistic Models; Male; Propensity Score; Retrospective Studies; Surgery
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2016.10.020

Background The purpose of this analysis was to assess the burden of Clostridium difficile infection in the hospitalized pediatric surgical population and to characterize its influence on the costs of care. Methods There were 313,664 patients age 1–18 years who underwent a general thoracic or abdominal procedure in the Kids’ Inpatient Database during 2003, 2006, 2009, and 2012. Logistic regression was used to model factors associated with the development of C difficile infection. A propensity score–matching analysis was performed to evaluate the influence of C difficile infection on mortality, duration of stay, and costs in similar patient cohorts. Population weights were used to estimate the national excess burden of C difficile infection on these outcomes. Results The overall prevalence of C difficile infection in the sampled cohort was 0.30%, with an increasing trend of C difficile infection over time in non–children's hospitals ( P  < .001). C difficile infection was associated with younger age, nonelective procedures, increasing comorbidities, and urban teaching hospital status ( P  < .001). An estimated 1,438 children developed C difficile infection after operation. After propensity score matching, the mean excess duration of stay and costs attributable to C difficile infection were 5.8 days and $12,801 ( P  < .001), accounting for 8,295 days spent in the hospital and $18.4 million (2012 USD) in spending annually. Conclusion C difficile infection is a relatively uncommon but costly complication after pediatric operative procedures. Given the increasing trend of C difficile infection among hospitalized surgical patients, there is substantial opportunity for reduction of inpatient burden and associated costs in this potentially preventable nosocomial infection.