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Published on: June 23, 2020
Risk factors for surgical site infections after pediatric spine operations
Lindsay D Croft1, Jean M Pottinger, Hsiu-Yin Chiang
1*Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore †Clinical Quality, Safety, and Process Improvement, University of Iowa Hospitals and Clinics, Iowa City ‡Department of Epidemiology, University of Iowa College of Public Health, Iowa City; and Departments of §Internal Medicine ¶Pediatrics, and ‖Orthopedics, University of Iowa Carver College of Medicine, Iowa City.
Insights
Surgical site infections (SSIs) after pediatric spinal fusion are linked to neuromuscular scoliosis and higher weight-for-age. Modifiable operative risks include prolonged surgery and blood loss, informing targeted prevention strategies for pediatric spinal fusion patients.
Area of Science:
- Pediatric Orthopedics
- Infectious Disease Prevention
- Surgical Outcomes Research
Background:
- Surgical site infections (SSIs) following pediatric spinal fusion present a growing concern.
- Identifying risk factors is crucial for improving patient outcomes and reducing healthcare burdens.
Purpose of the Study:
- To pinpoint modifiable risk factors associated with SSIs in pediatric spinal fusion procedures.
- To understand the outcomes and readmission factors related to SSIs in this patient population.
Main Methods:
- A matched case-control study design was employed.
- Data from 598 pediatric patients undergoing spinal fusion between 2001 and 2010 were analyzed.
- Bivariable and multivariable statistical analyses identified risk factors and outcomes.
Main Results:
- Gram-negative organisms were responsible for over 50% of SSIs.
- Preoperative risk factors included neuromuscular scoliosis and high weight-for-age.
- Operative factors associated with SSIs were significant blood loss and prolonged operation duration.
- SSIs led to an average increase of 2.8 hospital days post-surgery.
- Neuromuscular scoliosis was a significant predictor of hospital readmission.
Conclusions:
- Antimicrobial prophylaxis targeting gram-negative organisms may benefit pediatric spinal fusion patients.
- Potentially modifiable operative risks such as surgical duration, graft choice, and blood loss require attention.
- Neuromuscular scoliosis, elevated weight-for-age, and high American Society of Anesthesiologists scores can identify high-risk individuals for SSI prevention.
Study Design:
Matched case-control study.
Objective:
To identify modifiable risk factors for surgical site infections (SSIs) after pediatric spinal fusion.
Summary Of Background Data:
The number of SSIs after pediatric spinal fusions increased.
Methods:
Between July 2001 and July 2010, 22 of 598 pediatric patients who underwent spinal fusion at a university hospital acquired SSIs. Each patient with an SSI was matched with 2 controls by procedure date. Bivariable and multivariable analyses were used to identify risk factors for SSIs and outcomes of SSIs.
Results:
Gram-negative organisms caused more than 50% of the SSIs. By multivariable analysis, neuromuscular scoliosis (odds ratio [OR] = 20.8; 95% confidence interval [CI], 3.1-889.5; P < 0.0001) and weight-for-age at the 95th percentile or higher (OR = 8.6; 95% CI, 1.2-124.9; P = 0.02) were preoperative factors associated with SSIs. Blood loss (OR = 1.0; 95% CI, 1.0-1.0; P = 0.039) and allografts and allografts in combination with other grafts were operative risk factors for SSIs. The final overall risk model for SSIs was weight-for-age at the 95th percentile or higher (OR = 4.0; 95% CI, 1.4-∞; P = 0.037), American Society of Anesthesiologists score 3 or more (OR = 3.8; 95% CI, 1.6-∞; P = 0.01), and prolonged operation duration (OR = 1.0/min increase; 95% CI, 1.0-1.0; P = 0.004). SSIs were associated with 2.8 days of additional postoperative length of stay (P = 0.02). Neuromuscular scoliosis was the only factor significantly associated with hospital readmission (OR = 23.6; 95% CI, 3.8-147.3; P = 0.0007).
Conclusion:
Our results suggest that pediatric patients undergoing spinal fusion might benefit from antimicrobial prophylaxis that covers gram-negative organisms. Surgical duration, graft implantation, and blood loss are potentially modifiable operative risk factors. Neuromuscular scoliosis, high weight-for-age, and American Society of Anesthesiologists scores 3 or more may help surgical teams identify patients at high risk for SSI.
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