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Risk factors associated with surgical site infection after pediatric posterior spinal fusion procedure
W Matthew Linam1, Peter A Margolis, Mary Allen Staat
1Divisions of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA. matt.linam@cchmc.org
Insights
Obesity, higher American Society of Anesthesiologists (ASA) scores, and clindamycin antibiotic prophylaxis increase surgical site infection (SSI) risk after pediatric spinal fusion. Hypothermia during surgery may reduce SSI risk in these patients.
Area of Science:
- Pediatric surgery
- Infectious disease epidemiology
- Spinal fusion outcomes
Background:
- Surgical site infections (SSIs) are a significant concern following pediatric posterior spinal fusion.
- Identifying modifiable and non-modifiable risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To determine patient, surgical, and tissue hypoxia-related risk factors for SSIs after pediatric posterior spinal fusion.
- To analyze the association between obesity, anesthesia risk, antibiotic choice, and perioperative hypothermia with SSI development.
Main Methods:
- Retrospective case-control study conducted at a tertiary care children's hospital.
- Included patients undergoing posterior spinal fusion between 1995 and 2006, with SSIs identified via prospective surveillance.
- Matched 44 SSI cases with 132 controls and analyzed risk factors using univariate and multivariable logistic regression.
Main Results:
- The mean annual SSI rate was 4.4%.
- Significant univariate risk factors included obesity (BMI > 95th percentile), clindamycin prophylaxis, low antibiotic dose, and prolonged hypothermia.
- Multivariable analysis confirmed obesity, higher American Society of Anesthesiologists (ASA) score (>2), clindamycin use, and hypothermia as significant factors.
Conclusions:
- Obesity, ASA score >2, and clindamycin prophylaxis are independent risk factors for SSI after pediatric posterior spinal fusion.
- Perioperative hypothermia may offer a protective effect against SSIs in this population.
Objective:
To identify risk factors associated with surgical site infection (SSI) after pediatric posterior spinal fusion procedure by examining characteristics related to the patient, the surgical procedure, and tissue hypoxia.
Design:
Retrospective case-control study nested in a hospital cohort study.
Setting:
A 475-bed, tertiary care children's hospital.
Methods:
All patients who underwent a spinal fusion procedure during the period from January 1995 through December 2006 were included. SSI cases were identified by means of prospective surveillance using National Nosocomial Infection Surveillance system definitions. Forty-four case patients who underwent a posterior spinal fusion procedure and developed an SSI were identified and evaluated. Each case patient was matched (on the basis of date of surgery, +/-3 months) to 3 control patients who underwent a posterior spinal fusion procedure but did not develop an SSI. Risk factors for SSI were evaluated by univariate analysis and multivariable conditional logistic regression. Odds ratios (ORs), with 95% confidence intervals (CIs) and P values, were calculated.
Results:
From 1995 to 2006, the mean annual rate of SSI after posterior spinal fusion procedure was 4.4% (range, 1.1%-6.7%). Significant risk factors associated with SSI in the univariate analysis included the following: a body mass index (BMI) greater than the 95th percentile (OR, 3.5 [95% CI, 1.5-8.3]); antibiotic prophylaxis with clindamycin, compared with other antibiotics (OR, 3.5 [95% CI, 1.2-10.0]); inappropriately low dose of antibiotic (OR, 2.6 [95% CI, 1.0-6.6]); and a longer duration of hypothermia (ie, a core body temperature of less than 35.5 degrees C) during surgery (OR, 0.4 [95% CI, 0.2-0.9]). An American Society of Anesthesiologists (ASA) score of greater than 2, obesity (ie, a BMI greater than the 95th percentile), antibiotic prophylaxis with clindamycin, and hypothermia were statistically significant in the multivariable model.
Conclusion:
An ASA score greater than 2, obesity, and antibiotic prophylaxis with clindamycin were independent risk factors for SSI. Hypothermia during surgery appears to provide protection against SSI in this patient population.
