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Risk Factors Associated with Surgical Site Infection in Pediatric Patients Undergoing Spinal Deformity Surgery: A
Hiroko Matsumoto1,2, Matthew E Simhon2, Megan L Campbell2
1Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
Insights
Surgical site infections (SSI) are a concern in pediatric spinal surgery. Overweight, neuromuscular conditions, G-tube use, nonambulatory status, pelvic instrumentation, and increased blood loss are key risk factors for SSI in these patients.
Area of Science:
- Pediatric Orthopedics
- Infectious Disease Epidemiology
- Surgical Outcomes Research
Background:
- Surgical site infections (SSI) present a significant challenge in pediatric spinal deformity surgery, with high incidence rates reported in the US.
- Existing literature on SSI risk factors in pediatric spinal surgery shows inconsistent findings.
- Varied prevention practices contribute to the ongoing issue of SSI in this patient population.
Purpose of the Study:
- To systematically review and meta-analyze existing literature on risk factors associated with SSI in pediatric patients undergoing spinal surgery.
- To identify consistent risk factors contributing to SSI in pediatric spinal surgery.
- To provide evidence-based insights for improving SSI prevention strategies.
Main Methods:
- Systematic review and meta-analysis conducted following PRISMA-P guidelines.
- Included peer-reviewed English articles from 2000-2019 focusing on North American pediatric spinal deformity surgery and SSI risk factors.
- Assessed study quality and calculated weighted risk ratios and mean differences for identified risk factors.
Main Results:
- Overweight/obesity (RR 2.53), neuromuscular etiology (RR 2.84), gastrostomy tube use (RR 1.69), nonambulatory status (RR 3.45), and pelvic instrumentation (RR 3.39) significantly increased SSI risk.
- Patients with SSI experienced greater estimated blood loss (mean difference 158.38 mL).
- Analysis included 13 studies, with 7 rated average and 6 poor quality.
Conclusions:
- Overweight/obesity, neuromuscular etiology, G-tube use, nonambulatory status, pelvic instrumentation, and increased blood loss are significant risk factors for SSI in pediatric spinal surgery.
- The quality of existing studies is limited, highlighting the need for standardized definitions and robust methodologies.
- Future research should focus on high-quality studies to refine SSI prevention protocols for pediatric spinal surgery.
Background:
Considerable variation exists in surgical site infection (SSI) prevention practices for pediatric patients undergoing spinal deformity surgery, but the incidence of SSI has been reported to remain high in the United States. The literature reports various risk factors associated with SSI but findings are inconsistent. The purpose of this systematic review and meta-analysis was to assess the published literature investigating associations between various risk factors and SSI in pediatric patients undergoing spinal surgery.
Methods:
The systematic review and the meta-analysis were conducted according to Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines among peer-reviewed journals published in English between January 2000 and April 2019. Studies that involved pediatric patients with spinal deformity undergoing surgical procedures in North America and assessed risk factors for SSI were included. The quality of individual studies was assessed, and weighted risk ratios and mean differences were calculated for each risk factor.
Results:
Of 763 potential articles identified, 13 met inclusion criteria; 7 studies were rated as average and 6, as poor quality based on the quality checklist. The meta-analysis demonstrated that the SSI risk increased by the following factors: 2.53 (95% confidence interval [CI], 1.26 to 5.10) for overweight to obese patients compared with patients with normal weight, 2.84 (95% CI, 1.67 to 4.81) for patients with a neuromuscular etiology compared with non-neuromuscular etiology, 1.69 (95% CI, 1.41 to 2.02) for patients with a gastrostomy tube (G-tube) compared with those without, 3.45 (95% CI, 2.08 to 5.72) for nonambulatory patients compared with ambulators, and 3.39 (95% CI, 2.38 to 4.83) for patients with pelvic instrumentation compared with those without. Patients who developed SSI also had 158.38 mL (95% CI, 46.78 to 269.97 mL) greater estimated blood loss compared with those who did not.
Conclusions:
Despite the limited quality of the available studies and wide variety of populations and outcome definitions, evidence suggests that overweight to obese status, neuromuscular etiology, use of a G-tube, nonambulatory status, instrumentation to the pelvis, and greater estimated blood loss are risk factors for SSI. The use of a common SSI definition and strong methodology are warranted for future studies.
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete list of levels of evidence.
