{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T18:00:38Z","timestamp":1773597638692,"version":"3.50.1"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Orthop Relat Res"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Patients with geriatric hip fractures may be at increased risk for postoperative <jats:italic toggle=\"yes\">Clostridium difficile<\/jats:italic> colitis, which can cause severe morbidity and can influence hospital quality metrics. However, to our knowledge, no large database study has calculated the incidence of, factors associated with, and effect of <jats:italic toggle=\"yes\">C. difficile<\/jats:italic> colitis on geriatric patients undergoing hip fracture surgery.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Questions\/Purposes<\/jats:title>\n            <jats:p>To use a large national database with in-hospital and postdischarge data (National Surgical Quality Improvement Program<jats:sup>\u00ae<\/jats:sup> [NSQIP\u00ae]) to (1) determine the incidence and timing of <jats:italic toggle=\"yes\">C. difficile<\/jats:italic> colitis in geriatric patients who underwent surgery for hip fracture, (2) identify preoperative and postoperative factors associated with the development of <jats:italic toggle=\"yes\">C. difficile<\/jats:italic> colitis in these patients, and (3) test for an association between <jats:italic toggle=\"yes\">C. difficile<\/jats:italic> colitis and postoperative length of stay, 30-day readmission, and 30-day mortality.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patients and Methods<\/jats:title>\n            <jats:p>This is a retrospective study. Patients who were 65 years or older who underwent hip fracture surgery were identified in the 2015 NSQIP database. The primary outcome was a diagnosis of <jats:italic toggle=\"yes\">C. difficile<\/jats:italic> colitis during the 30-day postoperative period. Preoperative and procedural factors were tested for association with the development of <jats:italic toggle=\"yes\">C. difficile<\/jats:italic> colitis through a backward stepwise multivariate model. Perioperative antibiotic type and duration were not included in the model, as this information was not recorded in the NSQIP. The association between <jats:italic toggle=\"yes\">C. difficile<\/jats:italic> colitis and postoperative length of stay, 30-day readmission, and 30-day mortality were tested through multivariate regressions, which adjusted for preoperative and procedural characteristics such as age, comorbidities, and surgical procedure. A total of 6928 patients who were 65 years or older and underwent hip fracture surgery were identified.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The incidence of postoperative <jats:italic toggle=\"yes\">C. difficile<\/jats:italic> colitis was 1.05% (95% CI, 0.81%-1.29%; 73 of 6928 patients). Of patients who had <jats:italic toggle=\"yes\">C. difficile<\/jats:italic> colitis develop, 64% (47 of 73 patients) were diagnosed postdischarge and 79% (58 of 73 patients) did not have a preceding infectious diagnosis. Preoperative factors identifiable before surgery that were associated with the development of <jats:italic toggle=\"yes\">C. difficile<\/jats:italic> colitis included admission from any type of chronic care facility (versus admitted from home; relative risk [RR] = 1.98; 95% CI, 1.11-3.55; p = 0.027), current smoker within 1 year (RR = 1.95; 95% CI, 1.03-3.69; p = 0.041), and preoperative anemia (RR = 1.76; 95% CI, 1.07-2.92; p = 0.027). Patients who had pneumonia (RR = 2.58; 95% CI, 1.20-5.53; p = 0.015), sepsis (RR = 4.20; 95% CI, 1.27-13.82; p = 0.018), or \u201cany infection\u201d (RR = 2.26; 95% CI, 1.26-4.03; p = 0.006) develop after hip fracture were more likely to have <jats:italic toggle=\"yes\">C. difficile<\/jats:italic> colitis develop. Development of <jats:italic toggle=\"yes\">C. difficile<\/jats:italic> colitis was associated with greater postoperative length of stay (22 versus 5 days; p &lt; 0.001), 30-day readmission (RR = 3.41; 95% CI, 2.17-5.36; p &lt; 0.001), and 30-day mortality (15% [11 of 73 patients] versus 6% [439 of 6855 patients]; RR = 2.16; 95% CI, 1.22-3.80; p = 0.008).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>\n                                 <jats:italic toggle=\"yes\">C. difficile<\/jats:italic> colitis is a serious infection after hip fracture surgery in geriatric patients that is associated with 15% mortality. Patients at high risk, such as those admitted from any type of chronic care facility, those who had preoperative anemia, and current smokers within 1 year, should be targeted with preventative measures. From previous studies, these measures include enforcing strict hand hygiene with soap and water (not alcohol sanitizers) if a provider is caring for patients at high risk and those who are <jats:italic toggle=\"yes\">C. difficile<\/jats:italic>-positive. Further, other studies have shown that certain antibiotics, such as fluoroquinolones and cephalosporins, can predispose patients to <jats:italic toggle=\"yes\">C. difficile<\/jats:italic> colitis. These medications perhaps should be avoided when prescribing prophylactic antibiotics or managing infections in patients at high risk. Future prospective studies should aim to determine the best prophylactic antibiotic regimens, probiotic formula, and discharge timing that minimize postoperative <jats:italic toggle=\"yes\">C. difficile<\/jats:italic> colitis in patients with hip fractures.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence<\/jats:title>\n            <jats:p>Level III, therapeutic study.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11999.0000000000000099","type":"journal-article","created":{"date-parts":[[2018,4,27]],"date-time":"2018-04-27T16:11:12Z","timestamp":1524845472000},"page":"453-462","source":"Crossref","is-referenced-by-count":27,"title":["How Common\u2014and How Serious\u2014 Is Clostridium difficile Colitis After Geriatric Hip Fracture? 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