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Seromas Following Pediatric Spinal Deformity Surgery: Is Operative Management Necessary?
James Yu1, Anne M Dumaine, Connie Poe-Kochert
1Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
Insights
Conservative management of postoperative seromas after pediatric spinal deformity surgery is safe and effective. This approach avoids surgical intervention for seromas, leading to successful outcomes in most cases.
Area of Science:
- Pediatric Orthopedics
- Spinal Surgery
- Wound Management
Background:
- Seromas are common complications following pediatric spinal deformity surgery.
- Early surgical debridement is often performed to prevent deep surgical site infections (SSIs).
- A less invasive approach to seroma management has not been extensively studied.
Purpose of the Study:
- To evaluate the safety and efficacy of a conservative approach to managing postoperative seromas in pediatric spinal deformity surgery.
- To compare outcomes of conservative seroma management with traditional surgical interventions.
Main Methods:
- Retrospective review of patients under 21 who underwent primary posterior spinal fusion (1996-2016) and developed a postoperative seroma.
- Inclusion criteria: afebrile patients with soft, non-tender seroma without induration or erythema.
- Exclusion criteria: growing spine surgeries and revision procedures.
Main Results:
- 25 out of 790 patients developed a seroma, resolving in a mean of 12.2 days.
- All seromas were managed conservatively; 2 patients had needle aspiration, 5 received prophylactic antibiotics.
- No acute SSIs developed; 3 late SSIs occurred (18-38 months postoperatively).
Conclusions:
- Conservative management of postoperative seromas in pediatric spinal deformity surgery is appropriate.
- The role of seromas in the development of late infections requires further investigation.
- Further studies are needed to clarify the relationship between seromas and late infections.
Background:
Seromas are known complications after pediatric spinal deformity surgery. Although many surgeons perform an early debridement to prevent deep surgical site infections (SSIs), a less invasive approach to seroma management has not been studied. We hypothesized that a conservative approach to seroma management would be safe and yield equivalent outcomes.
Methods:
We performed a retrospective review of patients who developed a postoperative seroma with or without nonpurulent drainage. Inclusion criteria were patients below 21 years who underwent primary posterior spinal fusion from 1996 to 2016 and developed a postoperative wound seroma. Seromas were clinically defined as an afebrile patient with a fluid collection that was soft and nontender to palpation and without induration or erythema. Growing spine surgeries and revision procedures were excluded from this study.
Results:
Twenty-five of 790 total patients with a mean follow-up of 57.8 months (±48.5 mo) developed a seroma. Seromas were identified at a mean of 13.6 days postoperatively and resolved after a mean of 12.2 days following the presentation. Seromas occurred in 12 patients with idiopathic scoliosis, 12 with neuromuscular scoliosis, and 1 patient with Scheuermann kyphosis. All cases were managed conservatively with monitoring of the incision without an operative procedure. In cases of spontaneous drainage, a sterile dressing was applied to the wound and changed as needed until drainage ceased. Two patients underwent bedside needle aspiration and 5 patients received prophylactic antibiotics at the treating surgeon's discretion. All cases resolved spontaneously without development of an acute SSI. Three cases subsequently developed a late SSI (range, 18 to 38 mo postoperatively). Two had idiopathic scoliosis and 1 had neuromuscular scoliosis. None of these seromas drained spontaneously.
Conclusions:
Conservative management of postoperative seromas after pediatric spinal deformity surgery is appropriate. It is unclear if seromas contributed to the development of the 3 late infections. Further studies are needed regarding the relationship of late infections in seroma patients.
Level Of Evidence:
Level IV-case series.
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