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Surgical site infection in pediatric spinal fusion surgery revisited: outcome and risk factors after preventive
Wiriya Maisat1,2,3, Koichi Yuki1,2
1Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, USA.
Insights
Surgical site infections (SSI) after pediatric spinal fusion are rare but linked to specific risk factors. Optimizing antibiotic timing and skin prep can reduce SSI rates in children.
Area of Science:
- Pediatric Surgery
- Infectious Disease
- Spinal Fusion
Background:
- Surgical site infections (SSI) are a significant complication following pediatric spinal fusion.
- These infections increase patient morbidity, mortality, hospital stay, and healthcare costs.
- Understanding risk factors is crucial for refining prevention strategies in this pediatric population.
Purpose of the Study:
- To evaluate the incidence of surgical site infections (SSI) in children undergoing spinal fusion.
- To identify specific risk factors associated with SSI development despite standard preventive measures.
- To inform enhanced prevention protocols for pediatric spinal fusion surgery.
Main Methods:
- Retrospective analysis of 1111 pediatric patients (<18 years) undergoing spinal fusion surgery.
- Data collected from January 2017 to November 2021 at a quaternary pediatric medical center.
- Univariable analysis employed to identify associations between potential risk factors and SSI.
Main Results:
- A total of 14 patients (1.3%) developed SSI, with deep incisional infections being most common.
- Identified risk factors for SSI included low body weight, ASA classification ≥3, and neuromuscular scoliosis.
- Prolonged operative/anesthetic times, delayed antibiotic prophylaxis (≥60 min pre-incision), and povidone-iodine skin prep were significant risk factors.
Conclusions:
- Even with robust prevention bundles, specific factors increase SSI risk in pediatric spinal fusion.
- Timing of prophylactic antibiotics (ideally within 60 minutes of incision) is critical.
- Utilizing CHG-alcohol for skin preparation and adhering to strict protocols may further reduce SSI rates.
Background:
Surgical site infections (SSI) contribute to significant morbidity, mortality, length of stay, and financial burden. We sought to evaluate the incidence and risk factors of surgical site infection following pediatric spinal fusion surgery in patients for whom standard perioperative antibiotic prophylaxis and preventive strategies have been implemented.
Methods:
We conducted a retrospective study of children aged <18 years who underwent spinal fusion surgery from January 2017 to November 2021 at a quaternary academic pediatric medical center. Univariable analysis was used to evaluate associations between potential risk factors and SSI.
Results:
Of 1111 patients, 752 (67.6%) were female; median age was 14.2 years. SSI occurred in 14 patients (1.3%). Infections were superficial incisional (n=2; 14.3%), deep incisional (n=9; 64.3%), and organ/space (n=3; 21.4%). Median time to SSI was 14 days (range, 8 to 45 days). Staphylococcus aureus and Escherichia coli were the most frequently-isolated bacteria. Potential risk factors for SSIs included low body weight (Odds ratio (OR) 0.96, 95% confidence interval (CI) 0.93-0.99, p=0.026), ASA classification of ≥3 (OR 24.53, 95%CI 3.20-188.22, p=0.002), neuromuscular scoliosis (OR 3.83, 95%CI 3.82-78.32, p<0.001), prolonged operative time (OR 1.56, 95%CI 1.28-1.92, p<0.001), prolonged anesthetic time (OR 1.65, 95%CI 1.35-2.00, p<0.001), administration of prophylactic antibiotic ≥60 minutes before skin incision (OR 11.52, 95%CI 2.34-56.60, p=0.003), and use of povidone-iodine alone for skin preparation (OR 5.97, 95%CI 1.27-28.06, p=0.024).
Conclusion:
In the context of a robust bundle for SSI prevention; low body weight, ASA classification of ≥3, neuromuscular scoliosis, prolonged operative and anesthetic times, administration of prophylactic antibiotic ≥60 minutes before skin incision, and use of povidone-iodine alone for skin preparation increased the risk of SSI. Administration of prophylactic antibiotic within 60 minutes of skin incision, strict adherence to high-risk preventive protocol, and use of CHG-alcohol could potentially reduce the rate of SSI.
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