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Contributory factors to postoperative spinal fusion complications for children with myelomeningocele
Timothy Hatlen1, Kit Song, David Shurtleff
1Department of Pediatrics, University of Washington, and Seattle Children's Hospital, Seattle, WA 98105, USA.
Insights
Preoperative urinary tract infections and poor nutrition in children with myelomeningocele (MMC) significantly increase the risk of surgical wound infections. Treating these conditions before spinal surgery can improve patient outcomes.
Area of Science:
- Pediatric Orthopedics
- Infectious Disease
- Neurosurgery
Background:
- Patients with myelomeningocele (MMC) undergoing scoliosis surgery face a high risk of infectious complications.
- Neurogenic bladders in children with MMC often lead to asymptomatic urinary tract infections (UTIs).
- Limited literature exists on preventing postoperative infections in this vulnerable population.
Purpose of the Study:
- To investigate the correlation between preoperative nutritional status and/or positive urinary cultures and the risk of perioperative infection in pediatric patients with MMC undergoing spinal surgery.
Main Methods:
- Retrospective review of 59 patients with MMC undergoing 84 spinal fusion surgeries over 45 years.
- Correlation analysis between perioperative infections and preoperative hematocrit (Hct) levels and positive urinary cultures.
- Fisher Exact Probability Test used for statistical analysis.
Main Results:
- Poor preoperative nutrition (Hct ≤ 33) and positive urinary cultures were associated with the highest risk of perioperative wound infection (P=0.001).
- Patients with poor nutrition but no UTI, and those with adequate nutrition but a UTI, showed increased wound infection risks (P=0.03 and P=0.002, respectively).
Conclusions:
- Positive urine cultures before spinal surgery in children with MMC significantly elevate the risk of perioperative wound infections (P=0.002).
- Early detection and treatment of UTIs are crucial.
- Preoperative correction of UTIs, protein deficiencies, and low Hct levels (≤ 33) are recommended to mitigate infection risk.
Study Design:
This is a retrospective review of all children with myelomeningocele (MMC) who were undergoing surgery for scoliosis at our institution.
Objective:
Our aim was to investigate possible correlations between poor nutritional indexes and/or positive urinary cultures before surgery to perioperative infection risk.
Summary Of Background Data:
Patients who have scoliosis secondary to MMC have been shown to have a high rate of infectious complications. Many children with MMC have been found to have asymptomatic urinary tact infections due to their neurogenic bladder. There is little literature on risk factors for and ways to prevent postoperative infections for these patients.
Methods:
We reviewed a comprehensive database for the outcome for spinal fusion surgeries of 59 patients with MMC treated at our institution over the past 45 years. Perioperative infections were correlated to preoperative nutritional status (measured by patient hematocrit [Hct]) and presence of active infection using Fisher Exact Probability Test.
Results:
A total of 84 different spinal fusion operations for 59 patients were recorded. Patients presenting with poor preoperative nutrition (Hct
Conclusion:
Positive urine cultures obtained before spinal surgery for children with MMC significantly increased the risk for perioperative wound (P=0.002). Urinary tract infections can be easily detected and treated. We believe urinary culture, protein deficiencies, or Hct