Site-specific Surgical Site Infection Rates for Rib-based Distraction
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Published on: January 21, 2015
Brendan M Striano1, Christian A Refakis, Jason B Anari
1The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Distal surgical sites and initial implantation procedures carry a higher risk of surgical site infection (SSI) in children treated with rib-based distraction devices. This finding can inform improved prevention strategies for these fragile patients.
Area of Science:
- Pediatric Orthopedics
- Surgical Innovation
- Infection Control
Background:
- Rib-based distraction devices are vital for treating early onset scoliosis and thoracic insufficiency syndrome in children.
- Repeated surgeries and multiple incisions in pediatric patients increase the risk of surgical site infections (SSIs).
- A prospective database was created to evaluate infection rates and risk factors associated with different incision locations.
Purpose of the Study:
- To assess surgical site infection (SSI) rates in relation to incision location and procedure type for rib-based distraction devices.
- To identify specific risk factors contributing to SSIs in pediatric patients undergoing these treatments.
- To utilize a novel labeling system for precise documentation of surgical sites and infection occurrences.
Main Methods:
- Analysis of a prospective database of 166 pediatric patients treated with rib-based distraction devices between 2013 and 2016.
- Development and application of a novel surgical site labeling system categorizing incisions as proximal or distal.
- Collection of data on surgery type (implantation, expansion, revision/removal) and surgeon-adjudicated surgical site infections (SSIs).
Main Results:
- A total of 670 procedures were analyzed, with 1537 evaluable surgical sites (1299 proximal, 238 distal).
- Overall, 7.0% of procedures resulted in SSIs, affecting 24.1% of patients.
- Implantation procedures had the highest SSI rate (13.1%), and infections were more frequent at distal sites (P=0.02).
Conclusions:
- Distal surgical sites are significantly associated with a higher risk of SSIs compared to proximal sites.
- Rib-based distraction device implantation procedures demonstrate a greater risk of SSI than expansion or revision procedures.
- Findings can guide enhanced preventive measures, anticipatory guidance, and improved patient care for pediatric spinal deformities.
Background:
Implantable rib-based distraction devices have revolutionized the treatment of children with early onset scoliosis and thoracic insufficiency syndrome. Unfortunately, the need for multiple skin incisions and repeated surgeries in a fragile patient population creates considerable infection risk. In order to assess rates of infection for different incision locations and potential risk factors, we generated a prospectively collected database of patients treated with rib-based distraction devices.
Methods:
We analyzed a cohort of patients with thoracic insufficiency syndrome from various etiologies that our institution treated with rib-based distraction devices from 2013 to 2016. Surgery type (implantation, expansion, revision/removal), and surgeon adjudicated surgical site infection (SSI) were collected. For this study, we developed a novel, rib-based distraction device surgical site labeling system in which incisions could be labeled as either proximal or distal surgical exposure areas. Treating surgeons documented the operative site, procedure, and SSI site in real-time.
Results:
A total of 166 unique patients underwent 670 procedures during the study period, producing 1537 evaluable surgical sites; 1299 proximal and 238 distal. Patients were 6.81±4.0 years of age on average. Forty-seven procedures documented SSIs (7.0%), while 40 (24.1%) patients experienced an infection. Analysis showed significant variation in the rate of infection between implantation, and expansion, and revision procedures, with implantation procedures having the highest infection rate at 13.1% (P<0.01). Infections occurred more frequently at distal sites than proximal ones (P=0.02).
Conclusions:
Our novel, surgeon-entered, prospective quality improvement database has identified distal surgical sites as being at higher risk for SSI than proximal ones. Further, rib-based distraction device implantation procedures were identified as being at a greater risk for SSI than expansion or revision procedures. We believe this data can lead to improved prevention measures, anticipatory guidance, and patient care.
Level Of Evidence:
Level II-prognostic study.
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