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A Clinical Risk Model for Surgical Site Infection Following Pediatric Spine Deformity Surgery
Hiroko Matsumoto1,2, Elaine L Larson2,3, Shay I Warren4
1Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY.
Insights
This study developed a validated risk calculator to predict surgical site infections (SSI) in pediatric spinal deformity surgery. The tool aids in informed decision-making and targeted resource allocation for high-risk patients.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Infectious Disease Epidemiology
Background:
- Surgical site infection (SSI) remains a significant concern in pediatric spinal deformity surgery.
- Previous studies had limitations in analyzing multiple risk factors simultaneously.
- This study aimed to identify and model key predictors of SSI in this patient population.
Purpose of the Study:
- To evaluate a wide range of preoperative and intraoperative factors for predicting SSI.
- To develop and validate a predictive model for individual SSI risk assessment.
- To create a practical tool for clinical use in pediatric spinal deformity surgery.
Main Methods:
- Analysis of 3,092 pediatric spinal deformity surgeries from seven institutions.
- Utilized logistic regression and cross-validation to develop and validate a predictive model.
- Included patient, surgical, and hospital factors, defining SSI as per CDC criteria within 90 days.
Main Results:
- Identified key predictors: nonambulatory status, neuromuscular etiology, pelvic instrumentation, long procedure time (≥7 hours), high ASA grade (>2), revision surgery, low hospital volume (<100 spine cases/year), abnormal hemoglobin, and BMI (overweight/obese).
- The final model demonstrated good discrimination (AUC 0.76) and calibration.
- Developed a risk probability calculator and mobile application.
Conclusions:
- The validated risk calculator accurately predicts 90-day SSI probability in pediatric spinal deformity surgery.
- The tool enhances informed consent and shared decision-making processes.
- Facilitates selective deployment of resources for high-risk individuals.
Background:
Despite tremendous efforts, the incidence of surgical site infection (SSI) following the surgical treatment of pediatric spinal deformity remains a concern. Although previous studies have reported some risk factors for SSI, these studies have been limited by not being able to investigate multiple risk factors at the same time. The aim of the present study was to evaluate a wide range of preoperative and intraoperative factors in predicting SSI and to develop and validate a prediction model that quantifies the risk of SSI for individual pediatric spinal deformity patients.
Methods:
Pediatric patients with spinal deformity who underwent primary, revision, or definitive spinal fusion at 1 of 7 institutions were included. Candidate predictors were known preoperatively and were not modifiable in most cases; these included 31 patient, 12 surgical, and 4 hospital factors. The Centers for Disease Control and Prevention definition of SSI within 90 days of surgery was utilized. Following multiple imputation and multicollinearity testing, predictor selection was conducted with use of logistic regression to develop multiple models. The data set was randomly split into training and testing sets, and fivefold cross-validation was performed to compare discrimination, calibration, and overfitting of each model and to determine the final model. A risk probability calculator and a mobile device application were developed from the model in order to calculate the probability of SSI in individual patients.
Results:
A total of 3,092 spinal deformity surgeries were included, in which there were 132 cases of SSI (4.3%). The final model achieved adequate discrimination (area under the receiver operating characteristic curve: 0.76), as well as calibration and no overfitting. Predictors included in the model were nonambulatory status, neuromuscular etiology, pelvic instrumentation, procedure time ≥7 hours, American Society of Anesthesiologists grade >2, revision procedure, hospital spine surgical cases <100/year, abnormal hemoglobin level, and overweight or obese body mass index.
Conclusions:
The risk probability calculator encompassing patient, surgical, and hospital factors developed in the present study predicts the probability of 90-day SSI in pediatric spinal deformity surgery. This validated calculator can be utilized to improve informed consent and shared decision-making and may allow the deployment of additional resources and strategies selectively in high-risk patients.
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
