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A standardized protocol to reduce pediatric baclofen pump infections: a quality improvement initiative

Virendra R Desai, Jeffrey S Raskin, Arvind Mohan

    Journal of Neurosurgery. Pediatrics
    |January 27, 2018
    PubMed

    Insights

    A new protocol significantly reduced complications from intrathecal baclofen pumps in children. This quality improvement project lowered infection and complication rates, enhancing patient safety for spasticity and dystonia treatment.

    Area of Science:

    • Pediatric Neurosurgery
    • Quality Improvement
    • Infection Control

    Background:

    • Intrathecal baclofen pumps treat spasticity and dystonia in children.
    • Pediatric patients with comorbidities face high risks of implant complications and infections.

    Purpose of the Study:

    • To reduce baclofen pump-related infections and complications in pediatric patients.
    • To implement and evaluate a quality improvement project focused on infection prevention.

    Main Methods:

    • A unique workflow paradigm for baclofen pump implantation was developed and implemented.
    • Infection prevention protocols were created based on literature review and expert consensus.
    • Outcomes were retrospectively reviewed pre- and post-protocol implementation (August 2012-June 2016).

    Main Results:

    • A total of 128 surgeries were analyzed (64 pre-protocol, 64 post-protocol).
    • Infection rates decreased from 12.5% to 6.3% (p=0.225).
    • Complication rates significantly decreased from 23.4% to 9.4% (p=0.032), with a 60% relative risk reduction.

    Conclusions:

    • Implementation of the quality improvement protocol significantly lowered complication rates after intrathecal baclofen pump surgery.
    • Checklist standardization effectively reduced variability and improved patient outcomes.
    • The protocol demonstrated a substantial reduction in both infection and overall complication risks.

    Keywords:
    BMI = body mass indexCD = Clavien-DindoPDSA = Plan-Do-Study-Actbaclofen pumpcomplicationinfectionpediatric populationprotocolquality improvementspasticitysurgical technique

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