SESSION TITLE: Lung Transplantation Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: Studies on Clostridium difficile associated diarrhea (CDAD) prevalence and outcomes in lung transplant recipients are limited to data from single centers. The data with regards to nationwide prevalence and outcomes are lacking.
METHODS: Using the Nationwide Inpatient Sample from 2008, adult lung transplant recipients (LT) with CDAD were identified with ICD-9-CM code. The outcomes examined were prevalence of CDAD, severity of CDAD, its effects on inpatient mortality, length of stay and hospitalization charges. We defined severe CDAD if the patient developed megacolon, perforation, peritonitis or underwent colectomy in same admission.
RESULTS: There were 16,070 discharges for LT in 2008. 783 of these discharges (0.05%) had CDAD. In the non-transplant population, the prevalence of CDAD was 0.99%. When we performed adjusted analysis for non-transplant recipients, CDAD was a significant predictor for mortality in LT recipients (OR 1.75, 95% CI 1.69-1.80). The severity of CDAD was significantly higher in lung transplant patients. Colectomy rates were significantly higher in LT patients with CDAD than without CDAD (2.5% vs. 0.5%, p < 0.001). Bowel perforation was significantly higher in LT patients with CDAD than without CDAD (1.3% vs. 0.2%, p < 0.001). Peritonitis was significantly higher in LT patients with CDAD than without CDAD (1.85% vs. 0.32%, p < 0.001). In survivors, the mean length of stay was longer in those with CDAD than without CDAD (18.6 days vs. 10.6 days, p<0.001). In non-survivors, the mean length of stay was longer in those with CDAD than without CDAD (40.4 days vs. 30.9 days, p<0.001). In LT patients with CDAD, hospitalization charges were higher with a mean of $209116.7 (95% CI = $138364.2-$279869.1) when compared to a mean of $130149.9 in LT patients without CDAD (95% CI = $84275.7-$176024.1).
CONCLUSIONS: The prevalence and severity of CDAD was higher for LT patients versus non-LT patients.
CLINICAL IMPLICATIONS: CDAD was found to be an independent risk factor for mortality in hospitalized LT patients. CDAD also increased the burden on health care by increasing the length of stay and hospital costs. This emphasizes the importance of early diagnosis and the appropriate initiation of treatment for CDAD in LT patients.
DISCLOSURE: The following authors have nothing to disclose: Vijaya Sivalingam Ramalingam, Gagan Kumar, Tilottama Majumdar
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