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Published on: June 23, 2020
Characterizing antibiotic prophylaxis practices in pediatric deformity spinal surgery and impact on 30-day
Vivien Chan1, David L Skaggs2, Robert H Cho3
1UCLA Health, Los Angeles, 1131 Wilshire Blvd Suite 100, Santa Monica, CA, 90401, USA. vivienka@ualberta.ca.
Insights
Antibiotic prophylaxis, including presurgical intravenous, postoperative intravenous, and intraoperative topical antibiotics, significantly reduces infection rates in pediatric spinal fusion patients. These findings support standardized infection prevention protocols.
Area of Science:
- Pediatric Orthopedic Surgery
- Infectious Disease Prevention
- Spinal Deformity Correction
Background:
- Posterior spinal arthrodesis for scoliosis and kyphosis is a common pediatric procedure.
- Postoperative infection is a significant complication following spinal fusion surgery.
- Antibiotic prophylaxis is standard practice, but optimal regimens require further investigation.
Purpose of the Study:
- To analyze antibiotic prophylaxis strategies in pediatric patients undergoing posterior spinal arthrodesis.
- To determine the impact of various antibiotic prophylaxis practices on 30-day postoperative infection rates.
Main Methods:
- Retrospective cohort study utilizing the 2021 National Surgical Quality Improvement Program Pediatric database.
- Inclusion of pediatric patients (≤18 years) undergoing posterior arthrodesis for scoliosis or kyphosis.
- Statistical analysis including Fisher's exact test and multivariable regression to assess infection rates based on antibiotic use.
Main Results:
- A total of 6974 patients were analyzed, with a 30-day infection rate of 2.9%.
- Presurgical intravenous, postoperative intravenous, and intraoperative topical antibiotics were all associated with significantly lower infection rates (p<0.05).
- No significant difference in infection rates was observed between different intravenous antibiotic choices (cefazolin, vancomycin, clindamycin) or with added Gram-negative coverage.
Conclusions:
- Presurgical intravenous, postoperative intravenous, and intraoperative topical antibiotic use are effective in reducing postoperative infection rates in pediatric spinal fusion.
- The findings provide evidence for the development of standardized infection prevention protocols in this patient population.
- Further research can build upon these results to optimize antibiotic stewardship in pediatric spinal surgery.
Purpose:
The aim of this study was to characterize antibiotic prophylaxis practices in pediatric patients who have received posterior arthrodesis for spinal deformity and understand how these practices impact 30-day postoperative infection rates.
Methods:
This was a retrospective cohort study using the National Surgical Quality Improvement Program Pediatric database for year 2021. Patients 18 years of age or younger who received posterior arthrodesis for scoliosis or kyphosis correction were included. The outcome of interest was 30-day postoperative infection. Fisher's exact test and multivariable regression analysis were used to analyze the impact of intravenous antibiotic prophylaxis, intraoperative intravenous antibiotic redosing after 4 h, postoperative antibiotic prophylaxis, intraoperative topical antibiotics on 30-day postoperative infection, and various antibiotic prophylaxis regimens.
Results:
A total of 6974 patients were included in this study. The 30-day infection rate was 2.9%. Presurgical intravenous antibiotic (11.5% vs. 2.7%, p = 0.005), postoperative antibiotic (5.7% vs. 2.4%, p < 0.01), and intraoperative topical antibiotic (4.0% vs. 2.7%, p = 0.019) were associated with significantly reduced infection rates. There was no significant difference in infection rates between patients that received cefazolin versus vancomycin versus clindamycin. The addition of Gram-negative coverage did not result in significant differences in infection rates. Multivariable regression analysis found postoperative intravenous antibiotics and intraoperative topical antibiotics to reduce infection rates.
Conclusions:
We found the use of presurgical intravenous antibiotics, postoperative intravenous antibiotics, and intraoperative topical antibiotics to significantly reduce infection rates. Results from this study can be applied to future research on implementation of standardized infection prevention protocols.
Level Of Evidence:
Level II.
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