Hospital Readmission for C Difficile Recurrence Leads to Worse Outcomes

Being hospitalized a second time for recurrent cases of Clostridium difficile (C difficile) created worse outcomes for patients, according to a recent study.

Researchers from Massachusetts retroactively analyzed recurrent C difficile infection rehospitalizations in order to determine hospital mortality, length of stay, hospital costs, and 30-day readmission rates. They sourced their data from the State Inpatient Databases from California, Florida, Iowa, and New York collected between 2009 and 2013.

Recurrent C difficile prevalence has risen for a variety of reasons, said the researchers, and “it continues to vex clinicians, torment patients, and affect hospitals.” There’s also the fact that there is an economic burden from these recurrences, but there may be a difference between patients who are admitted for their recurrent C difficile infections and those who are admitted for another condition but with recurrent C difficile infection as a concurrent condition.

From more than 385,000 hospitalized patients with initial C difficile infection during the study time frame, about 100,000 required a rehospitalization, according to the researchers. A third of them had recurrent C difficile infection, while the rest had no code for C difficile infection. Nearly all of the recurrent C difficile infections were present on admission (99% of the primary diagnosis for recurrent cases and 88% of the secondary diagnosis for recurrent cases). The majority of the cases (92%) were community onset, healthcare facility-associated cases of C difficile, the researchers reported.

The researchers also found that those with a primary diagnosis of recurrent C difficile infection and the secondary diagnosis of C difficile infection were older than the non-C difficile patients. The secondary and non-C difficile groups had fewer females than the primary cohort, as well.

The costs were highest for the secondary diagnosis group, and lowest for the primary recurrent diagnosis cohort. Length of stay, however, was similar in primary recurrent and non-C difficile groups, though secondary recurrent cases were higher.

The 30-day readmissions barometer was the highest among non-C difficile patients and the lowest for primary recurrent patients. In all of the groups, the rate was more than 30%, though, the study authors wrote.

Compared to non-C difficile patients, primary and secondary recurrent C difficile infections were associated with a lower risk of death. Both recurrent groups had a longer length of stay and higher hospitalization costs compared with the non-C difficile group, they said. Secondary recurrent cases had the highest mean reimbursement gap among the 3 cohorts, at nearly $14,000 per hospitalization.

“We found that those patients who are readmitted with primary recurrent C difficile infection are different demographically and clinically from those with secondary recurrent infection and those without C difficile infection,” the study authors concluded. “Importantly, all groups, and secondary recurrent C difficile infections in particular, incurred a substantial deficit in reimbursements when compared with the expenditures, thus suggesting that more efficient models of care may be needed for these patients.”

The study, titled “Hospital readmission with Clostridium difficile infection as a secondary diagnosis is associated with worsened outcomes and greater revenue loss relative to principal diagnosis: A retrospective cohort study,” was published in Medicine.