S0251 Clostridioides difficile Infection Is Associated With Adverse Clinical Outcomes in Patients With Acute Diverticulitis: A Nationwide Study

Abstract

INTRODUCTION: Acute diverticulitis (AD) is a common gastrointestinal disease with a significant healthcare associated burden. Patients hospitalized with AD have many risk factors for developing Clostridioides difficile infection (CDI). CDI is associated with poor outcomes in many diseases but has yet to be studied in AD. METHODS: We utilized data from the National Inpatient Sample from January 2012 to October 2015 for patients hospitalized with AD and CDI. Primary outcomes were mortality, length of stay, and hospitalization cost were compared. Secondary outcomes were complications of diverticulitis and need for surgical interventions. Risk factors for mortality in acute diverticulitis and risk factors associated with CDI in AD patients were analyzed. RESULTS: Among 767,850 hospitalizations for AD, 8,755 also had CDI. A multivariate logistic regression analysis demonstrated that CDI was associated with increased risk of inpatient mortality (OR 2.02, 95% CI 1.38–2.96), prolonged duration of hospitalization by 3.7 days (95% CI, 3.38–4.02, P < 0.001) and had higher total hospitalization charges $74525 vs $37571 (P < 0.001). Patients who required surgery for AD had greater mortality than those who did not (0.9% vs 0.3%, P < 0.001). Patient with CDI in AD who underwent surgery had greater mortality than patients with CDI who did not require surgery (4.1% vs 0.9%, P < 0.001). Predictors of CDI among patients with AD included age (1.01 OR, 95% CI 1.01–1.02) female gender (1.12 OR, 95% CI 1.01–1.24), three or more comorbidities (1.81 OR, 95% CI 1.57–2.09), admissions to teaching hospitals (1.44 OR, 95% CI 1.22–1.70), length of stay (1.08, OR 95% CI 1.07–1.09) and inflammatory bowel disease (2.26, 95% CI 1.61–3.17). A multivariate logistic regression analysis for the impact of surgery and complicated diverticulitis was performed. Patients who required surgical interventions had increased mortality including colectomy (OR 2.36, 95% CI 1.83–3.06), colostomy (OR 2.99, 95% CI 2.30–3.90) anterior resection (OR 1.9, 95% CI 1.1–3.29) and abscess drainage (OR 1.85, 95% CI 1.39–2.47). Patients with complications of diverticulitis had increased mortality including obstruction (OR 1.33, 95% CI 1.07–1.66), perforation (OR 3.90, 95% CI 2.16–7.04) and hemorrhage (OR 1.73, 95% CI 1.38–2.18). CONCLUSION: CDI in AD is associated with increased mortality, length of stay and total hospital charges. Preventative measures should be made for at-risk patients with AD to decrease infection rate and poor outcomes.Table 1.: Patient Demographics and Characteristics, Interventions, Complications and Outcomes of Acute Diverticulitis with and without CDITable 2.: Risk factors associated with In-Hospital Mortality in Acute Diverticulitis