Abstract
Immunosuppressant use increases the risk of Clostridium difficile infection. To date no studies have analyzed the relationship between immunosuppressant use and Clostridium difficile infections after metabolic and bariatric surgery.
A retrospective analysis of the 2015-2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data was conducted. The MBSAQIP data includes information from 854 affiliated practices in the United States and Canada. Initial sample size was 760,076 MBS patients. After excluding participants due to missing variables (n= 188,106) and the use of surgical procedures other than Roux-en-Y gastric bypass and sleeve gastroplasty (n=129,712), final analyses were performed on 442,258 participants. Logistic regression models generated the odds of post-MBS Clostridium difficile infection by immunosuppressant status (+/-).
Unadjusted logistic regression analysis showed that patients using immunosuppressants were 95% more likely to have post-operative Clostridium difficile infection (OR=1.945, 95% CI= 1.230 to 3.075; p <0.001) versus MBS patients not taking immunosuppressants. After adjusting for age, gender, ethnicity, pre-operative BMI, diabetes status, and surgery procedure type, the association remained unaffected (aOR=1.956, 95% CI=1.236 to 3.095; p <0.01). Patients who completed the laparoscopic Roux-en-Y gastric bypass procedure had more than double the odds of developing Clostridium difficile infection compared to those who completed the laparoscopic sleeve gastrectomy procedure (OR=2.183, 95% CI=1.842 to 2.587; p < 0.0001).
Our results using a population-based sample of MBS patients show that those taking immunosuppressants have significantly higher risk of developing Clostridium difficile infection post-operatively. These findings suggest that patients using immunosuppressants should be closely monitored both pre- and post-procedure.
