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Surgical site infections in pediatric spinal surgery after implementation of a quality assurance program
Bradley Hammoor1,2, Hiroko Matsumoto3,4,5, Gerard Marciano1
1Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, USA.
Insights
Two infection-reducing programs significantly decreased surgical site infections (SSI) by 65.4% in pediatric spinal surgery patients. However, the programs
Area of Science:
- Pediatric Orthopedic Surgery
- Infectious Disease Prevention
- Healthcare Quality Improvement
Background:
- Post-operative surgical site infections (SSI) increase morbidity and healthcare costs in pediatric spinal surgery.
- Patients with neuromuscular conditions have a high incidence of SSI, with myelodysplasia and cerebral palsy patients exceeding 8% and 6% respectively.
- Effective infection reduction programs are crucial for improving outcomes in this vulnerable pediatric population.
Purpose of the Study:
- To evaluate the effectiveness of two infection-reducing programs in mitigating SSI incidence.
- To analyze SSI rates in pediatric patients undergoing spinal deformity surgery.
- To identify patient subgroups with the highest risk for SSI.
Main Methods:
- Retrospective cohort study of 1934 pediatric spine procedures (2008-2018).
- Inclusion criteria: patients aged 0-21 undergoing spinal surgery, including growing rod lengthening.
- Data collected via manual chart review.
Main Results:
- Two infection-reducing programs reduced SSI risk by 65.4% (RR=0.3, p=0.001).
- Initial instrumentation procedures showed a 68.8% lower SSI risk compared to other procedures (RR=0.3, p=0.002).
- Program effectiveness diminished over time, similar to previous initiatives.
Conclusions:
- Implementation of infection-reducing programs significantly decreased SSI incidence in pediatric spinal surgery.
- The reduction was particularly notable in patients undergoing initial instrumentation.
- A temporal decline in program effectiveness suggests a need for ongoing evaluation and potential re-implementation strategies.
Study Design:
Retrospective cohort study.
Objective:
To assess the effectiveness of two infection-reducing programs in mitigating the incidence of post-operative surgical site infections (SSI) in pediatric patients after spinal deformity surgery at our institution. Infections following spinal deformity surgery are associated with higher morbidity as well as significantly increased healthcare costs. SSI in patients with neuromuscular etiologies is especially high, exceeding 8 percent for myelodysplasia patients and 6 percent for cerebral palsy patients.
Methods:
Manual chart review was conducted for 1934 pediatric spine procedures in 1200 patients at our institution between 2008 and 2018. Patients between the ages of 0 and 21 having any spinal surgical procedure including lengthening of growing rods were included.
Results:
Institution of two separate infection-reducing programs reduced risk of SSI in this population by 65.4%, when adjusted for age and number of instrumentation levels (risk ratio [RR] = 0.3, 95% confidence interval [CI] = 0.2; 0.6, p = 0.001). Patients undergoing Initial Instrumentation demonstrated 68.8% less risk of SSI compared to those who had other types of surgical procedures, after adjusting for age and the number of level instrumented (RR = 0.3, 95% CI 0.2; .6, p = 0.002). It was observed that the effect of each of these infection-reducing programs diminished with time. This effect was also observed with prior programs implemented at our institution.
Conclusion:
The incidence of SSI decreased following the implementation of two infection-reducing programs especially in patients undergoing Initial Instrumentation procedures. However, time-series analysis suggests these programs may have maximal effect immediately following institution that diminishes with time.
Level Of Evidence:
Level III.
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