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A novel risk calculator predicting surgical site infection after spinal surgery in patients with cerebral palsy
Hiroko Matsumoto1,2, Jeanne M Franzone1, Rishi Sinha1
1Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, New York, USA.
Insights
A new risk calculator predicts surgical site infections (SSI) in pediatric patients with cerebral palsy (CP) undergoing spinal surgery. Key factors include non-ambulatory status and diaper dependence, aiding in better patient care decisions.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Infectious Disease Epidemiology
Background:
- Surgical site infections (SSI) pose a significant risk for patients with cerebral palsy (CP) undergoing spinal surgery.
- Accurate prediction of SSI risk is crucial for optimizing patient management and outcomes in this vulnerable population.
Purpose of the Study:
- To develop and validate a predictive risk calculator for surgical site infections (SSI) in pediatric patients with cerebral palsy (CP) undergoing spinal surgery.
- To identify key preoperative factors associated with increased SSI risk.
Main Methods:
- A multicenter retrospective cohort study involving pediatric patients with CP who underwent spinal fusion.
- Development of a risk calculator using preoperative factors, selecting the model with the highest discrimination and calibration.
- Validation of the developed model in a separate patient cohort.
Main Results:
- The final prediction model identified non-ambulatory status, diaper dependence, younger age, severe coronal curve, behavioral disorder, and revision surgery as significant risk factors for SSI.
- The risk calculator demonstrated a predictive ability of 73.4% in the development stage and 74.3% in the validation stage, with excellent calibration in both.
- The incidence of SSI was 11% in the development cohort and 8.2% in the validation cohort.
Conclusions:
- A validated risk calculator is now available to predict SSI risk in pediatric CP patients undergoing spinal surgery.
- This tool can enhance clinical decision-making, improve patient care, and support hospital quality metrics and reimbursement processes.
Aim:
To develop and validate a risk calculator based on preoperative factors to predict the probability of surgical site infection (SSI) in patients with cerebral palsy (CP) undergoing spinal surgery.
Method:
This was a multicenter retrospective cohort study of pediatric patients with CP who underwent spinal fusion. In the development stage, preoperative known factors were collected, and a risk calculator was developed by comparing multiple models and choosing the model with the highest discrimination and calibration abilities. This model was then tested with a separate population in the validation stage.
Results:
Among the 255 patients in the development stage, risk of SSI was 11%. A final prediction model included non-ambulatory status (odds ratio [OR] 4.0), diaper dependence (OR 2.5), age younger than 12 years (OR 2.5), major coronal curve magnitude greater than 90° (OR 1.3), behavioral disorder/delay (OR 1.3), and revision surgery (OR 1.3) as risk factors. This model had a predictive ability of 73.4% for SSI, along with excellent calibration ability (p = 0.878). Among the 390 patients in the validation stage, risk of SSI was 8.2%. The discrimination of the model in the validation phase was 0.743 and calibration was p = 0.435, indicating 74.3% predictive ability and no difference between predicted and observed values.
Interpretation:
This study provides a risk calculator to identify the risk of SSI after spine surgery for patients with CP. This will allow us to enhance decision-making and patient care while providing valid hospital comparisons, public reporting mechanisms, and reimbursement determinations.
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