Introduction:

Patients undergoing cystectomy for bladder cancer are colonized with Clostridium difficile at a higher rate than all comers, which puts them at an increased risk for Clostridium difficile infection (CDI). Post-operative CDI devastates recovery, as up to 12.5% of patients will have a serious adverse event. We aim to evaluate pre-operative risk factors for CDI in patients undergoing cystectomy for bladder cancer utilizing National Surgical Quality Improvement (NSQIP) prospective database.

Methods:

Men and women undergoing cystectomy with diagnosis of bladder cancer between 2015-2017 were included. Baseline demographics including age, gender, race, comorbidities, pre-operative labs, ASA class, and functional status were included. Univariate and multivariable logistic regression were used to evaluate risk factors for and complications of Clostridium difficile infection in the immediate recovery period.

Results:

A total of 5,041 patients were included in the analysis.  One hundred and fifty seven (4%) were diagnosed with CDI post-operatively. Patients with diagnosis of post-operative CDI were more likely to be female [(27.4) vs. (16.9), p=0.001] and present with lower preoperative albumin [3.78 (0.52) vs. 3.92 (0.48) p=0.003] (Table 1).  The four strongest risk factors for post-operative Clostridium difficile infection were female sex (OR 1.752), neobladder (OR 1.526), low pre-operative albumin (OR 1.46), and low pre-operative hematocrit (OR 1.04). Patients with diagnosis of CDI were more likely to experience a readmission within 30 days [51(32.5) vs. 999 (20.5), p=0.001], increased hospital time [12.58(9.03) vs. 8.6(6.44)] and inpatient mortality [10(6.4) vs. 121(2.5)].  

Conclusion:

We identified female gender and low pre-operative albumin as significant pre-operative risk factors for CDI. Notably, the association between female gender and increased risk for Clostridium difficile infection has not previously been reported. Since CDI occurs more frequently in women and is associated with longer length of stay, readmission, and post-operative mortality, CDI may contribute to the gender disparities of bladder cancer outcomes.

Funding: N/A