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Gastric bypass linked to higher C. diff risk

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LAS VEGAS — Patients with obesity who undergo Roux-en-Y gastric bypass surgery have an increased risk for Clostridium difficile infection, according to the results of a retrospective study presented at ACG 2016.

“With bariatric surgery use gaining momentum, limited data exist on the impact of bariatric surgery on CDI rates,” Emmanuel Ugbarugba, MD, MPA, of the Ohio State University Wexner Medical Center, said during his presentation. “The aim of our study was to investigate CDI rates after Roux-en-Y gastric bypass [RYGB] surgery and vertical sleeve gastrectomy (VSG).”

Using the 2013 National Readmission Database, Ugbarugba and colleagues compared postoperative CDI rates among 40,191 RYGB patients, 45,644 VSG patients and 10,995 controls with obesity who underwent ventral hernia repair (VHR) surgery without bowel resection. No CDIs occurred in the 90 days before surgeries were performed.

“The potential confounders in our study were age, [sex], index surgery length of hospital stay, emergent surgery, antibiotics used and number of comorbidities,” Ugbarugba said.

RYGB patients were slightly older, had more comorbidities and longer length of stay, and had more admissions for urinary tract infection and pneumonia after surgery compared with VSG patients.

RYGB patients had steadily increased CDI rates over time compared with VSG patients (within 30 days, adjusted OR = 4.5; 95% CI, 1.6-12.6; within 31-120 days, aOR = 9.8; 95% CI, 1.2-77).

Furthermore, 0.05% of RYGB patients experienced at least one CDI relapse within 120 days, while none of the VSG patients did.

VHR patients were older than RYGB patients, and had more comorbidities, emergent surgeries, and UTI and pneumonia rates after surgery. While these two groups had comparable CDI rates within 30 days after their surgeries, CDI rates increased within 31 to 120 days in the RYGB patients compared with the VHR patients (aOR = 6.67; 95% CI, 1.75-25.39).

Causality could not be confirmed due to the retrospective nature of the study, and confounding factors like PPI use could not be assessed, Ugbarugba said.

“The CDI admission and relapse rates were higher in gastric bypass compared to [VSG] and even VHR controls within 120 days after surgery,” he concluded. “A multitude of factors could be contributing, and further studies validating this risk, including mechanistic explanations, are warranted.” – by Adam Leitenberger

Reference:

Ugbarugba E, et al. Abstract #40. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 17-19, 2016; Las Vegas, NV.

Disclosures: The researchers report no relevant financial disclosures.