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Deep Surgical Site Infections Following Pediatric Cervical Spine Surgery
David A Porter1, Michael P Glotzbecker, M Timothy Hresko
1*Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY †Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.
Insights
Deep surgical site infections (SSI) after pediatric cervical spine surgery are rare, occurring in 2.7% of cases. The study found that connective tissue disorders (CTD) significantly increase the risk of SSI in these young patients.
Area of Science:
- Pediatric Orthopedics
- Spine Surgery
- Infectious Disease
Background:
- Deep surgical site infections (SSI) following pediatric cervical spine surgery are not well-studied.
- There is a lack of established risk factors or benchmark data for SSI in this specific patient population.
Purpose of the Study:
- To identify risk factors associated with deep SSI in pediatric patients undergoing cervical spine surgery.
- To establish predictors for SSI in this unique surgical context.
Main Methods:
- Retrospective case series including 112 pediatric patients undergoing cervical spine surgery.
- Analysis of patient and surgical characteristics using penalized likelihood logistic regression.
- Evaluation of factors such as age, diagnosis, comorbidities, fusion levels, surgical approach, implants, allograft, halo use, BMI, revision status, antibiotic dosing, and occipital plating.
Main Results:
- The incidence of deep SSI was 2.7% (3 out of 112 patients).
- Patients with connective tissue disorders (CTD) had a significantly higher odds of developing SSI (OR=12, P=0.02).
- All deep SSIs were gram-positive infections requiring further intervention and prolonged antibiotic treatment.
Conclusions:
- The incidence of deep SSI in pediatric cervical spine surgery is 2.7%.
- Connective tissue disorder (CTD) is the only significant predictor of deep SSI in this patient group.
- Early identification and management of CTD may be crucial for preventing SSI.
Of Background Data:
This is the first reported series looking specifically at factors associated with deep surgical site infections (SSI) following pediatric cervical spine surgery.
Objective:
To identify risk factors present in pediatric patients who are at risk for SSI following cervical spine surgery.
Design:
Level of evidence: level IV-retrospective case series.
Introduction:
To date there are no studies regarding SSI in pediatric cervical spine surgery and thus no benchmark data or risk factors have been identified.
Methods:
Patients with acute deep SSIs occurring within 90 days of the index operation were identified. Patient and surgical characteristics were analyzed for possible predictors of SSI outcome using penalized likelihood logistic regression analysis. Characteristics analyzed included: age, diagnosis, comorbidity, levels fused, approach, implants used, allograft, halo, body mass index, revision, antibiotic dosing, and occipital plating.
Results:
A total of 112 patients were included in the study at a mean age of 12.5 years (2 to 18 y). Comorbidities were present in 51 (46%) patients, 15 patients had a documented connective tissue disorder (CTD). The mean number of levels fused was 3.7 (2 to 7) and mean number of screws was 4.4 (2 to 11). Allograft was used alone in 48 patients, occipital plating in 28 patients, and a halo in 39 patients. Deep SSI occurred in 3 patients: two of which had a CTD (1 Trisomy 21, 1 Ehlers-Danlos) and 1 patient with postradiation cervical kyphosis. All were gram-positive infections requiring return to operating room with prolonged IV antibiotics. All patients recovered and fused with spinal implant retention. The incidence of deep SSI was 2.7%. It was determined that a CTD was the only significant predictor of SSI. Subjects with a CTD had 12 times the odds of SSI [odds ratio=12 (1.5, 137.0); P=0.02].
Conclusions:
In our series of pediatric patients the incidence of a deep SSI was 2.7%. The only predictor of SSI was the presence of a CTD.
