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Impact of a Multidisciplinary Approach on Surgical Site Infections (SSIs) in Pediatric Posterior Spine Fusions (PSF):
Tyler Sullivan1, Kelea Damp, Carson Keeter
1From the Children's Hospital Colorado, University of Colorado, Aurora, CO.
Insights
Surgical site infections (SSIs) decreased in low-risk pediatric spine fusion patients following the Target Zero initiative. High-risk patients still require targeted strategies to reduce SSIs.
Area of Science:
- Pediatric surgery
- Infectious disease control
- Spinal fusion outcomes
Background:
- Surgical site infections (SSIs) are a significant complication following pediatric posterior spine fusion (PSF).
- The Target Zero (TZ) initiative was implemented in 2007 to mitigate SSIs through standardized protocols.
- This study assesses SSI trends from 2012 to 2022, building on earlier data from 2006-2012.
Purpose of the Study:
- To evaluate the effectiveness of the Target Zero (TZ) initiative in reducing surgical site infections (SSIs) in pediatric posterior spine fusion (PSF) patients.
- To compare SSI rates between high-risk (HR) and low-risk (LR) patient cohorts.
- To identify factors associated with SSI development and assess changes in SSI rates over time.
Main Methods:
- Retrospective review of 1476 pediatric patients (ages 10-18) who underwent PSF between July 2012 and December 2022.
- Patients were categorized into high-risk (HR) and low-risk (LR) groups based on comorbidities.
- Analysis of SSI rates, associated factors, and protocol compliance.
Main Results:
- Overall SSI rate was 3.3% (49/1476).
- SSI rates were significantly higher in HR patients (6.87%) compared to LR patients (0.92%) (P < 0.001).
- SSI rates in LR patients decreased from 2.7% (2008-2012) to 0.92% (2012-2022), while HR rates remained stable (6.5% vs 6.87%). Protocol compliance improved from 85% to 98%.
Conclusions:
- The Target Zero initiative has successfully reduced SSIs in low-risk pediatric spine fusion patients.
- High-risk pediatric patients continue to experience high SSI rates, necessitating the development of targeted interventions.
- Sustained adherence to prevention protocols is crucial for managing SSIs in pediatric spinal surgery.
Background:
Surgical site infections (SSIs) after pediatric posterior spine fusion (PSF) remain a notable concern. Our institution launched the Target Zero (TZ) initiative in 2007 to reduce SSIs through standardized prevention protocols. This study evaluates SSI rates from 2012 to 2022, following the initiative's early years (2006 to 2012).
Methods:
After IRB approval, we conducted a retrospective review of 1476 PSF patients aged 10 to 18 from July 2012 to December 2022. Patients were stratified into high-risk (HR) and low-risk (LR) groups based on comorbidities. Infection rates and associated factors were analyzed.
Results:
Of 1476 patients, 495 were HR and 981 LR. SSI rates were significantly higher in HR patients than in LR patients (6.87% vs 0.92%, P < 0.001). The number of levels fused and estimated blood loss did not differ significantly between cohorts with and without infection. HR patients who developed an SSI had longer procedures (302.4 vs 252.5 minutes; P < 0.03). Time of procedure was not significantly different in LR patients with or without infection. Compliance with TZ antibiotic protocols was high (100% LR, 98% HR). Compared with the previous cohort (2008 to 2012), SSI rates in LR patients declined from 2.7% (2008 to 2012) to 0.92% (2012 to 2022), while rates in HR patients remained stable (6.87% vs 6.5%). Protocol compliance improved from 85% to 98%.
Conclusion:
SSI rates in LR patients have declined over the past decade, reflecting sustained effectiveness of TZ protocols. Rates in HR patients remained unchanged, highlighting the need for targeted strategies for high-risk populations. These findings are consistent with known risk factors of SSIs in pediatric spine fusion surgery.
