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Strategies reducing risk of surgical-site infection following pediatric spinal deformity surgery
Hiroko Matsumoto1,2, Lisa Bonsignore-Opp3, Shay I Warren4
1Department of Orthopedics & Sports Medicine, Boston Children's Hospital, Boston, MA, 02115, USA. Hm2174@cumc.columbia.edu.
Insights
Quality improvement programs and povidone-iodine irrigation significantly reduce surgical-site infection (SSI) risk in pediatric spinal surgery patients. These strategies enhance patient safety by lowering individual SSI probability.
Area of Science:
- Surgical Infection Prevention
- Pediatric Spinal Surgery Outcomes
- Evidence-Based Healthcare Practices
Background:
- Surgical-site infection (SSI) prevention is complex, especially for individual patients with varying characteristics.
- Identifying effective strategies tailored to patient risk factors is crucial for improving surgical outcomes.
Purpose of the Study:
- To investigate the association between specific preventive strategies and individual patient risk of SSI.
- To estimate the reduction in SSI probability attributable to these strategies, considering baseline risks.
Main Methods:
- Retrospective analysis of pediatric spinal deformity fusion patients across 7 institutions (2004-2018).
- Evaluated strategies: topical vancomycin, bone graft, povidone-iodine (PI) irrigation, multilayered closure, impermeable dressing, quality improvement (QI) programs, and antibiotic prophylaxis adherence.
- Utilized multiple regression modeling adjusted for patient and surgical factors to assess strategy impact on SSI risk.
Main Results:
- Enrollment in QI programs and PI irrigation showed significant associations with reduced SSI.
- Topical vancomycin, multilayered closure, and correct antibiotic dosing trended towards SSI reduction.
- In the final model, QI programs remained significant, and PI irrigation decreased SSI risk by an average of 49% and 18% at the individual patient level.
Conclusions:
- QI programs and PI irrigation effectively reduce SSI risk in pediatric spinal surgery patients, even after accounting for baseline characteristics.
- Implementing these evidence-based practices is recommended to enhance patient safety and minimize SSI incidence.
Background:
Identifying beneficial preventive strategies for surgical-site infection (SSI) in individual patients with different clinical and surgical characteristics is challenging. The purpose of this study was to investigate the association between preventive strategies and patient risk of SSI taking into consideration baseline risks and estimating the reduction of SSI probability in individual patients attributed to these strategies.
Methods:
Pediatric patients who underwent primary, revision, or final fusion for their spinal deformity at 7 institutions between 2004 and 2018 were included. Preventive strategies included the use of topical vancomycin, bone graft, povidone-iodine (PI) irrigations, multilayered closure, impermeable dressing, enrollment in quality improvement (QI) programs, and adherence to antibiotic prophylaxis. The CDC definition of SSI as occurring within 90 days postoperatively was used. Multiple regression modeling was performed following multiple imputation and multicollinearity testing to investigate the effect of preventive strategies on SSI in individual patients adjusted for patient and surgical characteristics.
Results:
Univariable regressions demonstrated that enrollment in QI programs and PI irrigation were significantly associated, and topical vancomycin, multilayered closure, and correct intraoperative dosing of antibiotics trended toward association with reduction of SSI. In the final prediction model using multiple regression, enrollment in QI programs remained significant and PI irrigation had an effect in decreasing risks of SSI by average of 49% and 18%, respectively, at the individual patient level.
Conclusion:
Considering baseline patient characteristics and predetermined surgical and hospital factors, enrollment in QI programs and PI irrigation reduce the risk of SSI in individual patients. Multidisciplinary efforts should be made to implement these practices to increase patient safety.
Level Of Evidence:
Prognostic level III study.
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