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Published on: December 3, 2017
Laboratory predictors for risk of revision surgery in pediatric septic arthritis
Jessica J M Telleria1, Rosemary A Cotter2, Viviana Bompadre2
1Department of Orthopaedics and Sports Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA. Telleria@uw.edu.
Insights
Pediatric septic arthritis often requires revision surgery. Elevated C-reactive protein (CRP) and positive blood cultures at presentation or post-operatively predict the need for repeat surgical intervention.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Surgical Outcomes
Background:
- Pediatric septic arthritis can lead to severe complications, including growth abnormalities and death.
- Some children necessitate multiple surgical procedures for infection eradication.
- Assessing factors predicting surgical failure is crucial for optimal patient management.
Purpose of the Study:
- Determine the failure rate of single incision and drainage (I&D) for pediatric septic arthritis.
- Identify pre-operative risk factors associated with surgical failure.
- Analyze post-operative C-reactive protein (CRP) trends in relation to surgical outcomes.
Main Methods:
- Retrospective review of medical records for 105 children with septic arthritis.
- Single and multivariate statistical analyses were employed to identify risk factors.
- Evaluation of pre-operative and post-operative CRP levels, blood cultures, and clinical presentation.
Main Results:
- Twenty percent of children required revision surgery, with a higher mean age in this group.
- Delayed diagnosis, elevated CRP at presentation, positive blood culture, and age were associated with revision surgery in bivariate analysis.
- Elevated CRP on post-operative days 1-4 and positive blood cultures were significant predictors of requiring multiple surgeries.
Conclusions:
- Positive blood cultures and marked CRP elevations at presentation or early post-operatively are linked to revision surgery.
- These findings can inform surgical planning to minimize the need for repeat procedures.
- Early identification of at-risk patients can guide management strategies for pediatric septic arthritis.
Background:
Reported complications of pediatric septic arthritis range from minor growth abnormalities to potentially life-threatening conditions and death; some children require multiple surgeries for eradication of infection. The purpose of this study is: (1) to determine the failure rate of a single surgical incision and drainage (I&D) in pediatric septic arthritis, (2) to identify risk factors for failure which are detectable at the time of initial presentation, and (3) to trend post-operative C-reactive protein (CRP) values to see if there is a difference between children who fail a single I&D and those who do not.
Methods:
The medical records for 105 children who underwent operative management of septic arthritis were retrospectively reviewed. Single and multivariate analyses were performed.
Results:
Eighty-four children required one surgical intervention [mean age 5.18 years (±4.01); 38 females (45 %), 46 males (55 %)], 21 children required revision surgery [mean age 8.16 years (±4.54); 4 females (19 %), 17 males (81 %)], and the overall rate of revision surgery was 20 %. Delayed diagnosis (p = 0.015), elevated CRP at presentation (p = 0.000), positive blood culture (p = 0.000), and age (p = 0.009) were all associated with revision surgery in bivariate analysis. In multivariate analysis, CRP at presentation and positive blood culture were significant risk factors for revision surgery (p = 0.005 and p = 0.025, respectively). Additionally, markedly elevated CRP levels on post-operative days (POD) 1-4 were each independently significant risk factors for requiring multiple surgeries (all p < 0.000). Fever, elevated erythrocyte sedimentation rate, and leukocyte count were not risk factors for multiple surgeries.
Conclusions:
In this study, a positive blood culture or marked elevation in CRP at presentation or on POD 1-4 were associated with revision surgery. These findings may help improve surgical planning for both the initial surgery in order to avoid revisions, as well as revision surgery, should it be indicated.
Level Of Evidence:
III.
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