Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://gr.elmerpub.com

Original Article

Volume 19, Number 1, February 2026, pages 18-27

Trends and Impact of Clostridioides difficile Infection on Thirty-Day Readmissions and Outcomes Following Coronary Artery Bypass Grafting: A Seven-Year National Analysis

Figure 1. Kaplan-Meier curve depicting the 30-day readmission proportion of patients with and without CDI (blue line: CABG admission without CDI, red line: CABG admission with CDI). CDI: Clostridioides difficile infection; CABG: coronary artery bypass grafting.

**Table 1.** Demographic Characteristics of the Study Cohort
Variables	CABG admissions without CDI (n = 1,274,038)	CABG admissions with CDI (n = 5,567)	P value
CDI: Clostridioides difficile infection; CABG: coronary artery bypass grafting.
Mean age in years (standard error)	66.32 (66.26–66.38)	68.58 (68.16–69.00)	< 0.001
Age groups
18 to 65 years	511,606 (40.16%)	1,733 (31.13%)	< 0.001
More than 65 years	762,431 (59.84%)	3,834 (68.87)	< 0.001
Gender
Male	965,361 (75.77%)	3,608 (64.81%)	< 0.001
Female	308,676 (24.23%)	1,959 (35.19%)	< 0.001
Charlson Comorbidity Index
0	146,344 (11.49%)	234 (4.20%)	< 0.001
1	271,851 (21.34%)	632 (11.35%)	< 0.001
2	278,019 (21.82%)	892 (16.02%)	< 0.001
3 or more	577,822 (45.35%)	3,808 (68.40%)	< 0.001
Hospital bed size
Small	123,128 (9.66%)	502 (9.02%)	0.350
Medium	306,171 (24.03%)	1,231 (22.11%)	0.055
Large	844,738 (66.30%)	3,834 (68.87%)	0.022
Hospital location and teaching status
Non-metropolitan	31,631 (2.48%)	142 (2.55%)	0.858
Metropolitan non-teaching	185,475 (14.56%)	780 (14.01%)	0.466
Metropolitan teaching	1,056,931 (82.96%)	4,646 (83.46%)	0.555
Insurance
Medicare	735,456 (59.91%)	3,912 (72.80%)	< 0.001
Medicaid	90,780 (7.40%)	381 (7.09%)	0.564
Private insurance	372,517 (30.34%)	995 (18.52%)	< 0.001
Self-pay	28,805 (2.35%)	85 (1.59%)	0.042
Income quartile
1st quartile	342,190 (16.76%)	1,541 (17.23%)	0.375
2nd quartile	363,756 (17.83%)	1,547 (17.29%)	0.425
3rd quartile	637,149 (31.21%)	2,854 (31.92%)	0.472
4th quartile	698,182 (34.20%)	3,001(33.56%)	0.707

Table 1. Demographic Characteristics of the Study Cohort

Variables

CABG admissions without CDI (n = 1,274,038)

CABG admissions with CDI (n = 5,567)

P value

CDI: Clostridioides difficile infection; CABG: coronary artery bypass grafting.

Mean age in years (standard error)

66.32 (66.26–66.38)

68.58 (68.16–69.00)

< 0.001

Age groups

18 to 65 years

511,606 (40.16%)

1,733 (31.13%)

< 0.001

More than 65 years

762,431 (59.84%)

3,834 (68.87)

< 0.001

Gender

Male

965,361 (75.77%)

3,608 (64.81%)

< 0.001

Female

308,676 (24.23%)

1,959 (35.19%)

< 0.001

Charlson Comorbidity Index

146,344 (11.49%)

234 (4.20%)

< 0.001

271,851 (21.34%)

632 (11.35%)

< 0.001

278,019 (21.82%)

892 (16.02%)

< 0.001

3 or more

577,822 (45.35%)

3,808 (68.40%)

< 0.001

Hospital bed size

Small

123,128 (9.66%)

502 (9.02%)

0.350

Medium

306,171 (24.03%)

1,231 (22.11%)

0.055

Large

844,738 (66.30%)

3,834 (68.87%)

0.022

Hospital location and teaching status

Non-metropolitan

31,631 (2.48%)

142 (2.55%)

0.858

Metropolitan non-teaching

185,475 (14.56%)

780 (14.01%)

0.466

Metropolitan teaching

1,056,931 (82.96%)

4,646 (83.46%)

0.555

Insurance

Medicare

735,456 (59.91%)

3,912 (72.80%)

< 0.001

Medicaid

90,780 (7.40%)

381 (7.09%)

0.564

Private insurance

372,517 (30.34%)

995 (18.52%)

< 0.001

Self-pay

28,805 (2.35%)

85 (1.59%)

0.042

Income quartile

1st quartile

342,190 (16.76%)

1,541 (17.23%)

0.375

2nd quartile

363,756 (17.83%)

1,547 (17.29%)

0.425

3rd quartile

637,149 (31.21%)

2,854 (31.92%)

0.472

4th quartile

698,182 (34.20%)

3,001(33.56%)

0.707

**Table 2.** Complications and Outcomes During Indexed Hospital Admission for CABG
Outcomes	Total hospitalizations with CABG, age > 18 (n = 1,279,605)
CABG: coronary artery bypass grafting; C. diff: Clostridioides difficile infection; CI: confidence interval; OR: odds ratio.
30-day readmissions	93,653 (7.35%)	703 (12.63%)	1.42 (1.26–1.60)	< 0.001
Mortality	32,917 (2.58%)	648 (11.64%)	2.72 (2.37–3.12)	< 0.001
Ventilator use > 24 h	9,659 (0.76%)	76 (1.37%)	1.46 (1.34–1.64)	0.017
Cardiac arrest	26,032 (2.04%)	421 (7.56%)	2.55 (2.16–3.00)	< 0.001
Cardiogenic shock	120,981 (9.50%)	1,497 (26.89%)	2.33 (2.10–2.58)	< 0.001
Surgical site infection	2,994 (0.24%)	57 (1.02%)	2.41 (1.58–3.67)	< 0.001
Post-procedure sepsis/septic shock	31,996 (2.51%)	1,450 (26.05%)	8.28 (7.36–9.32)	< 0.001
Acute kidney injury	278,837 (21.89%)	3,039 (54.59%)	2.88 (2.59–3.20)	< 0.001
Vasopressor use	72,798 (5.71%)	532 (9.56%)	1.46 (1.26–1.68)	< 0.001
Blood transfusion	157,674 (12.38%)	1,218 (21.88%)	1.41 (1.27–1.56)	< 0.001
	Mean differences (95% CI)
Mean length of stay in days	10.34 (10.27–10.41)	27.10 (26.18–28.02)	–	< 0.001
Mean total hospitalization charge ($)	249,633.7 (245,046.1–254,221.3)	548,493 (523,685.8–573,300.2)	–	< 0.001

Table 2. Complications and Outcomes During Indexed Hospital Admission for CABG

Outcomes

Total hospitalizations with CABG, age > 18 (n = 1,279,605)

Without C. diff (n = 1,274,038)

With C. diff (n = 5,567)

Adjusted OR (95% CI)

P value

CABG: coronary artery bypass grafting; C. diff: Clostridioides difficile infection; CI: confidence interval; OR: odds ratio.

30-day readmissions

93,653 (7.35%)

703 (12.63%)

1.42 (1.26–1.60)

< 0.001

Mortality

32,917 (2.58%)

648 (11.64%)

2.72 (2.37–3.12)

< 0.001

Ventilator use > 24 h

9,659 (0.76%)

76 (1.37%)

1.46 (1.34–1.64)

0.017

Cardiac arrest

26,032 (2.04%)

421 (7.56%)

2.55 (2.16–3.00)

< 0.001

Cardiogenic shock

120,981 (9.50%)

1,497 (26.89%)

2.33 (2.10–2.58)

< 0.001

Surgical site infection

2,994 (0.24%)

57 (1.02%)

2.41 (1.58–3.67)

< 0.001

Post-procedure sepsis/septic shock

31,996 (2.51%)

1,450 (26.05%)

8.28 (7.36–9.32)

< 0.001

Acute kidney injury

278,837 (21.89%)

3,039 (54.59%)

2.88 (2.59–3.20)

< 0.001

Vasopressor use

72,798 (5.71%)

532 (9.56%)

1.46 (1.26–1.68)

< 0.001

Blood transfusion

157,674 (12.38%)

1,218 (21.88%)

1.41 (1.27–1.56)

< 0.001

Mean differences (95% CI)

Mean length of stay in days

10.34 (10.27–10.41)

27.10 (26.18–28.02)

–

< 0.001

Mean total hospitalization charge ($)

249,633.7 (245,046.1–254,221.3)

548,493 (523,685.8–573,300.2)

–

< 0.001

**Table 3.** Top Primary Diagnoses at Readmission in CDI and Non-CDI
Serial number	ICD-10 code	Name	Total (% total)
1	I110	Hypertensive heart disease with heart failure	7,690 (8.21%)
2	I130	Hypertensive heart disease and CKD with heart failure and stage 1 through stage 4 CKD, or unspecified CKD	5,816 (6.21%)
3	J90	Pleural effusion, not elsewhere classified	4,805 (5.13%)
4	A419	Sepsis, unspecified organism	4,203 (4.48%)
5	I2699	Other pulmonary embolism without acute cor pulmonale	3,016 (3.22%)
The top five primary diagnoses for readmission among a total of 94,356 readmissions are listed. CDI: Clostridioides difficile infection; CABG: coronary artery bypass grafting; ICD-10: International Classification of Diseases, 10th Revision; CKD: chronic kidney disease.
1	A419	Sepsis, unspecified organism	209 (29.72%)
2	A0472	Enterocolitis due to Clostridioides difficile, not specified as recurrent	168 (23.89%)
3	A047	Enterocolitis due to Clostridioides difficile	140 (19.91%)
4	I130	Hypertensive heart and CKD with heart failure and stage 1 through stage 4 CKD, or unspecified CKD	40 (5.68%)
5	A414	Sepsis due to anaerobes	37 (5.26%)

Table 3. Top Primary Diagnoses at Readmission in CDI and Non-CDI

Serial number

ICD-10 code

Name

Total (% total)

CABG without CDI (n = 93,653)

I110

Hypertensive heart disease with heart failure

7,690 (8.21%)

I130

Hypertensive heart disease and CKD with heart failure and stage 1 through stage 4 CKD, or unspecified CKD

5,816 (6.21%)

J90

Pleural effusion, not elsewhere classified

4,805 (5.13%)

A419

Sepsis, unspecified organism

4,203 (4.48%)

I2699

Other pulmonary embolism without acute cor pulmonale

3,016 (3.22%)

Serial number

ICD-10 code

Name

Total (% total)

CABG with CDI (n = 703)

The top five primary diagnoses for readmission among a total of 94,356 readmissions are listed. CDI: Clostridioides difficile infection; CABG: coronary artery bypass grafting; ICD-10: International Classification of Diseases, 10th Revision; CKD: chronic kidney disease.

A419

Sepsis, unspecified organism

209 (29.72%)

A0472

Enterocolitis due to Clostridioides difficile, not specified as recurrent

168 (23.89%)

A047

Enterocolitis due to Clostridioides difficile

140 (19.91%)

I130

Hypertensive heart and CKD with heart failure and stage 1 through stage 4 CKD, or unspecified CKD

40 (5.68%)

A414

Sepsis due to anaerobes

37 (5.26%)

**Table 4.** Number of CABG Admissions and Incidence of CDI (2016–2022)
Year	Total CABG admissions (P = 0.670)	Total CDI among CABG admission (% total) (P < 0.001)	30-day readmissions among all index admissions (% total) (P < 0.001)
CDI: Clostridioides difficile infection; CABG: coronary artery bypass grafting.
2016	194,278	1,347 (0.69%)	16,732 (8.61%)
2017	194,059	1,016 (0.52%)	14,966 (7.71%)
2018	187,899	883 (0.47%)	14,129 (7.52%)
2019	190,966	673 (0.35%)	13,871 (7.26%)
2020	161,450	506 (0.31%)	11,232 (6.96%)
2021	175,536	591 (0.34%)	11,824 (6.74%)
2022	175,417	551 (0.31%)	11,602 (6.61%)

Table 4. Number of CABG Admissions and Incidence of CDI (2016–2022)

Year

Total CABG admissions (P = 0.670)

Total CDI among CABG admission (% total) (P < 0.001)

30-day readmissions among all index admissions (% total) (P < 0.001)

CDI: Clostridioides difficile infection; CABG: coronary artery bypass grafting.

2016

194,278

1,347 (0.69%)

16,732 (8.61%)

2017

194,059

1,016 (0.52%)

14,966 (7.71%)

2018

187,899

883 (0.47%)

14,129 (7.52%)

2019

190,966

673 (0.35%)

13,871 (7.26%)

2020

161,450

506 (0.31%)

11,232 (6.96%)

2021

175,536

591 (0.34%)

11,824 (6.74%)

2022

175,417

551 (0.31%)

11,602 (6.61%)