Background: Obesity is associated with disturbances in the gut microbiota which is a risk factor for Clostridium difficile infection (CDI). Bariatric surgery can induce substantive changes to the gut microbiota which may affect the risk of developing CDI.
Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program captures variables specific to bariatric surgery from 832 centers. Patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) in 2016 and 2017 were identified. Primary outcomes included the prevalence and predictors of CDI after bariatric surgery. A multivariable logistic regression model determined preoperative factors predictive of 30-day CDI.
Results: A total of 78,222 LRYGB and 222,968 LSG were included. The overall incidence of CDI was low with 0.13% developing CDI. Rates of CDI were two times higher after LRYGB compared to LSG (0.2 vs 0.1%, p < 0.001). Although CDI rates were low, CDI was associated with increased post-operative complications. Multivariable analysis identified chronic kidney disease (OR 2.37, 95%CI 1.09-5.15, p = 0.03) and history of venous thromboembolism (OR 2.06, 95%CI 1.29-3.29, p = 0.002) as being most predictive of developing CDI with more than a twofold increase in risk. Patients undergoing LRYGB had an increased risk of CDI compared to LSG (OR 1.65, 95%CI 1.31-2.09, p < 0.001). White race, female sex, and obstructive sleep apnea also increased risk of CDI.
Conclusions: The incidence of CDI following bariatric surgery is relatively low with LRYGB having a higher risk than LSG. Furthermore, CDI is associated with significant adverse outcomes post-operatively but had no increased risk of mortality.
Keywords: Bariatric surgery; Clostridium difficile infection; Roux-en-Y gastric bypass; Sleeve gastrectomy.