Predictors, timing, and outcomes of Clostridium difficile infection following liver and pancreatic resection.

BACKGROUND

Clostridium difficile infection (CDI) is a common healthcare-associated infection. We assessed the incidence, timing, risk factors, and outcomes of CDI following liver and pancreatic resection.

METHODS

Adults undergoing elective hepatic or pancreatic resection were identified in ACS-NSQIP (2015-2021). The primary exposure was 30-day postoperative CDI. Outcomes included 30-day mortality, non-home discharge, unplanned readmission, and length of stay (LOS). Multivariable regression analyses were conducted.

RESULTS

Among 76,083 patients (liver: 30,145 [39.6%], pancreas: 45,938 [60.4%]), 860 (1.1%) developed CDI, including 236 hepatic and 624 pancreatic cases. Overall, 44.8% occurred within the first postoperative week. Patients with CDI were more often aged ≥75 years, ASA III-V, on preoperative dialysis, and had CHF (all p<0.05). Following hepatic resection, CDI was associated with increased mortality (aOR 3.64, 95%CI 1.60-8.28), readmission (aOR 2.78, 95%CI 2.00-3.85), and longer LOS (+3.25 days, 95%CI 2.82-3.68). Following pancreatic resection, CDI was associated with readmission (aOR 2.29, 95%CI 1.89-2.78) and prolonged LOS (+3.00 days, 95%CI 2.76-3.24).

DISCUSSION: CDI occurred in 1.1% of HP surgery patients, nearly half within the first postoperative week, and was associated with worse outcomes. Early identification of high-risk patients may improve prevention and management.