LAUSR

AIM To identify the incidence, associated factors, and impact of hospital-acquired Clostridium difficile infection (CDI) among patients who have undergone orthopedic surgery. METHODS We retrospectively reviewed the charts of all adults patients who underwent orthopedic surgery from January 2016 through December 2017 at a tertiary hospital. RESULTS Of 7363 patients who underwent orthopedic surgical procedures, 52 (0.7%) developed hospital-acquired CDI. The independent factors associated with CDI were age ≥65 years (adjusted odds ratio [aOR], 3.4; P < 0.001), preoperative hospital stay ≥3 days (aOR, 3.7; P < 0.001), operating time ≥3 hours (aOR, 2.5; P < 0.005), and antibiotic use for infection treatment (aOR, 4.3; P < 0.001). After adjusting for the timing of CDI using an multi-state model, the mean excess LOS attributable to CDI was 2.8 days (95% CI, 0.4-5.3). The impact of CDI on excess LOS was more evident among patients aged ≥65 years (4.4 days; 95% CI, 1.8-7.0) and those with any comorbidity (5.6 days; 95% CI, 3.0-8.1). CONCLUSIONS The overall incidence of CDI after orthopedic surgery was 0.7%. The occurrence of CDI after orthopedic surgery contributes to increased LOS. The greatest impact of CDI on LOS occurs among elderly patients and patients with comorbidities.