Risk Factors for Clostridioides difficile Infection After Otolaryngologic Surgery: An ACS-NSQIP Analysis

Objective: To examine the incidence and risk factors of Clostridioides difficile infection (CDI) after otolaryngologic surgery. Methods: A retrospective cohort study of subjects undergoing otolaryngologic surgery was performed using the 2016 to 2021 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). The incidence of CDI and potential risk factors were assessed. Results: One-hundred eighty-five surgical encounters experienced postoperative CDI out of 149 960, with a CDI incidence of 0.12% (8.8 cases per 10,000 patient-days). The greatest number of postoperative CDI was observed in head and neck reconstructive surgeries. On bivariate analysis, risk factors significantly and practically associated with the occurrence of CDI after otolaryngologic surgery were older age and longer operating times. Multiple logistic regression revealed that the CDI rate did not differ among otolaryngology subspecialties but was influenced by age, functional status, and operating times after controlling for relevant confounders. Conclusions: CDI after otolaryngologic surgery is a serious, costly complication with an incidence comparable to the national CDI rate. Knowledge of the preoperative risk factors associated with CDI may aid in the prevention of such infection after otolaryngologic procedures, thus decreasing patient morbidity and healthcare cost.