A multidisciplinary approach improves infection rates in pediatric spine surgery
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Michael R Ballard1, Nancy H Miller, Ann-Christine Nyquist
1Department of Orthopaedic Surgery, The Musculoskeletal Research Center, Aurora, CO, USA.
Insights
A multidisciplinary task force reduced surgical site infections in pediatric spine surgery by nearly 50%. This initiative demonstrated clinical significance in preventing infections, highlighting the impact of targeted prevention protocols.
Area of Science:
- Pediatric Surgery
- Infectious Disease Prevention
- Spinal Surgery Outcomes
Background:
- Surgical site infections (SSI) are a significant complication in pediatric spinal surgery, increasing healthcare costs and patient morbidity.
- A multidisciplinary task force, Target Zero, was established to develop and implement SSI prevention protocols.
- Elective pediatric spinal surgeries pose a risk for SSIs, necessitating focused intervention strategies.
Purpose of the Study:
- To evaluate the effectiveness of the Target Zero initiative in reducing SSI rates in pediatric spinal surgery.
- To compare SSI rates before and after the implementation of multidisciplinary prevention protocols.
- To assess the clinical significance and impact of the intervention on infection rates in high-risk and low-risk patient groups.
Main Methods:
- Retrospective review of 394 patient charts undergoing elective spinal surgery between April 2006 and September 2008.
- Categorization of patients into high-risk (HR) and low-risk (LR) cohorts, analyzed pre- and post-Target Zero initiation.
- Statistical comparison of SSI rates and relative risk reduction across different patient groups over a 1-year follow-up period.
Main Results:
- Overall SSI rates decreased from 7.8% to 4.5% post-intervention.
- High-risk patients showed a reduction in SSI rates from 12.9% to 6.5%.
- A relative risk reduction of 43% for all patients and 49.3% for high-risk patients was observed.
Conclusions:
- The Target Zero initiative demonstrated clinically meaningful reductions in SSI rates, approaching a 50% relative risk reduction.
- The study highlights the effectiveness of a multidisciplinary team in implementing protocols to decrease infection rates in pediatric spine surgery.
- The findings suggest that targeted prevention strategies are crucial for improving outcomes in this patient population.
Background:
Surgical site infections (SSI) associated with elective pediatric spinal surgery are a commonly reported complication, increasing hospital length of stay, readmissions, operations, and financial costs. In July 2007, a multidisciplinary task force, designated Target Zero, was created to address this issue and establish prevention protocols at our institution.
Methods:
A consecutive series of 394 patient charts from April 2006 to September 2008 were retrospectively reviewed to identify patients who developed an SSI secondary to elective spinal surgery. Four cohorts were evaluated; high-risk (HR) and low-risk (LR) patients who underwent surgery before (April 2006 to June 2007) and after (July 2007 to September 2008) Target Zero initiation. The definition of HR included diagnoses of cerebral palsy, spina bifida, muscle disease, paralytic deformities, and vertebral column resections. Patients were followed for 1 year to meet The Center for Disease Control-National Health Safety Network's definition of an SSI with an implantable device. Overall infection rates were determined for each group and compared statistically.
Results:
A total of 192 patients (70 HR and 122 LR) underwent surgery before, and 202 patients (92 HR and 110 LR) underwent surgery after Target Zero initiation. Overall infection rates were reduced from 7.8% to 4.5% (P=0.203), 12.9% to 6.5% (P=0.183), and 4.9% to 2.7% (P=0.505) for all patients, HR patients, and LR patients, respectively. The relative risk reduction was 43.0% for all patients, 49.3% for HR patients, and 44.6% for LR patients.
Conclusions:
Although decreases in overall infection rates were not statistically significant, the results from Target Zero were shown to be clinically meaningful with a relative risk reduction approaching 50% overall and in defined subgroups. Based on the number needed to treat analysis, 1 infection in every 16 patients within the HR group, and 1 in 30 overall, was prevented up to 1 year postoperatively. This study is the first to document the effectiveness of a multidisciplinary team implementing protocols for decreasing infection rates in pediatric spine surgery.
