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Updated: Mar 12, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Variability of Surgical Site Infection With VEPTR at Eight Centers: A Retrospective Cohort Analysis
Sumeet Garg1, Micaela Cyr1, Tricia St Hilaire2
1University of Colorado, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA.
Study Design:
Retrospective review.
Objectives:
To describe clinical characteristics and infection rates in modern vertical expandable prosthetic titanium rib (VEPTR) surgery.
Summary Of Background Data:
Prior studies have demonstrated infection rates from 10% to 30% with VEPTR surgery.
Methods:
A retrospective query was done on an institutional review board-approved, multicenter prospectively collected database for patients implanted with VEPTR from 2007 to 2013 at eight sites. This identified 213 patients with appropriate data for analysis. Average follow-up was 4.1 years (range 1.7-6.3). Data collected included a Classification of Early-Onset Scoliosis (C-EOS) diagnosis, American Society of Anesthesiologists Physical Status (ASA-PS), major Cobb angle, construct type, clinical symptoms, and microbiology. The distribution of infection rates across all the study sites was compared. The exact p value was estimated by Monte Carlo simulation.
Results:
Overall, 18% (38/213) of patients implanted with VEPTR developed infection requiring operative debridement. There were significantly different infection rates among the sites, ranging from 2.9% to 42.9% (p = .029). The average time to infection was 70 days (range 8-236) after the infecting procedure. The majority of infections were due to gram-positive bacteria (80%, 44/55), the most prevalent being methicillin-sensitive Staphylococcus aureus (45%, 25/55). There were 20 patients (53%, 20/38) with either partial or complete implant removal to resolve infection; however, only 3 of 38 (8%) of these resulted in abandonment of VEPTR treatment. There was no difference in infection rate across the primary C-EOS diagnosis categories (p = .21) or based on ASA score (p = .53). After controlling for study site, the odds ratio of an infection following an implant procedure versus an expansion was 2.8 (p = .002). There was no difference in the odds ratio of an infection between the other procedure types (implant, expansion, exchange/revision).
Conclusions:
There were significant differences in infection rates between sites. The variability in infection rate indicates a need for guided efforts to standardize best practices for infection control in VEPTR surgery.
Level Of Evidence:
III, therapeutic study.
Insights
This study found that infection rates after vertical expandable prosthetic titanium rib (VEPTR) surgery varied significantly between medical centers. Standardizing infection control practices is crucial to improve patient outcomes in VEPTR procedures.
Area of Science:
- Orthopedic surgery
- Pediatric surgery
- Infectious disease
Background:
- Vertical expandable prosthetic titanium rib (VEPTR) surgery is used for early-onset scoliosis.
- Previous studies reported VEPTR surgery infection rates between 10% and 30%.
Purpose of the Study:
- To evaluate clinical characteristics and infection rates in modern VEPTR surgery.
- To identify factors influencing infection risk in VEPTR procedures.
Main Methods:
- Retrospective review of a multicenter, prospectively collected database (2007-2013).
- Analysis of 213 patients undergoing VEPTR surgery, collecting data on diagnosis, comorbidities, surgical details, and microbiology.
- Comparison of infection rates across eight study sites using Monte Carlo simulation.
Main Results:
- Overall infection rate was 18%, with significant variation between sites (2.9% to 42.9%).
- Gram-positive bacteria, particularly methicillin-sensitive Staphylococcus aureus, were the most common pathogens.
- Infection following an implant procedure had a higher odds ratio (2.8) compared to an expansion procedure.
Conclusions:
- Significant disparities in VEPTR surgery infection rates exist across different institutions.
- Standardization of infection control protocols is essential to mitigate VEPTR surgery-related infections.
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