Old Age, Functional Status Linked to CDI Risk Following Hip Fracture Surgery

Published on: 

Increased age, male sex, COPD, CHF, dependent functional status, and C. difficile infection were associated with increased mortality within 30 days of surgery.

Geriatric adults are at an increased risk of clostridium difficile infections (CDI) following hiop fracture surgery if they have certain risk factors, including older age, COPD, and the male sex are linked to increased mortality rates.1

A team, led by Lucas C. Voyvodic, Department of Orthopaedic Surgery, Maimonides Medical Center, reported the incidence and timing of C difficile colitis in geriatric patients who underwent hip fracture surgery and identified preoperative factors associated with developing C difficile colitis and mortality.

The Study

In the retrospective study, the investigators used the 2016-2019 ACS Targeted Hip Fracture database merged with the ACS-NSQIP database for patients undergoing surgery for hip fracture.

The investigators sought primary outcomes of incidence, preoperative, and postoperative risk factors for CDI and mortality.

The team used Chi-squared tests to compare demographics between the patients infected and not infected and used logistic regression models to compute the odds ratios (OR) testing for the association of independent factors on developing CDI postoperatively and mortality.

CDI Risk

Overall, 0.81% of the patients developed CDI within 30 days of hip fracture surgery, 50% of which were diagnosed within 9 days of the operation.

They also identified preoperative and hospital-associated factors associated with CDI, including ≥2 days until operation (OR, 1.88; 95% confidence interval [CI], 1.39–2.55; P <0.001) and dependent functional status (OR, 1.43; 95% CI 1.14–1.79; P = 0.002).

The investigators then adjusted for multiple comorbdities and found increased age, male sex, COPD, CHF, dependent functional status, and C. difficile infection were associated with increased mortality within 30 days of surgery (all P <0.001).

Clostridium difficile colitis is a serious infection after hip fracture surgery in geriatric patients with an incidence of about 1%,” the authors wrote. “Patients at increased risk should be targeted with preventative measures to prevent the morbidity from this complication.”

Negative Outcomes

Last year, investigators found a high burden of death and hospital costs is associated with recurrent clostridium difficile infections for older adults.

A team, led by Paul Feuerstadt, MD, Yale University School of Medicine, identified the mortality, cost, and health care resource utilization for Medicare beneficiaries at least 65 years old who suffered a primary CDI episode only or any recurrent CDI.

In the retrospective, observational, claim analysis study, the investigators examined patients who had an inpatient or outpatient CDI diagnosis claim to Medicare and continuous enrollment in Medicare parts, A, B, and D during the 12-month pre- and post-index periods.

Overall, the recurrent CDI cohort were nearly 10 times likelier to suffer from a CDI-associated death (25.4%) than the primary CDI cohort (2.7%).

Decedents were more likely to be older, have higher Charlson Comorbidity Index scores, and were more likely to be Black compared to survivors.

Finally, the investigators adjusted for comorbidities.

Here, they found decedents during follow-up had higher hospitalization rates (pCDI: OR, 1.83; P <.001; rCDI: OR, 2.58; P <.001). Decedents with recurrent CDI had more intensive care unit use (OR, 2.34; P <.001) compared with survivors.

Overall decedents had a longer length of stay (pCDI: +3.1 days; P <.01; rCDI: +2.6 days), and higher total cost (pCDI: +303%; P <.001; rCDI: +297%; P <.001).


Voyvodic, L.C., Rodriguez, A.N., Gordon, A.M. et al. Clostridium difficile colitis following geriatric hip fracture surgery: incidence, trends, and risk factors from 45,910 patients. Eur J Orthop Surg Traumatol (2023).