Surgical Site Infection Following Primary Definitive Fusion for Pediatric Spinal Deformity: A Multicenter Study of Rates, Risk Factors, and Pathogens.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Aug 2021
15 Aug 2021
Historique:
pubmed:
27
1
2021
medline:
19
8
2021
entrez:
26
1
2021
Statut:
ppublish
Résumé
A retrospective multicenter study. To determine the surgical site infection (SSI) rate, associated risk factors, and causative pathogens in pediatric patients with spinal deformity. There have been no extensive investigations of the risk factors for SSI in Japan. Demographic data, radiographic findings, and the incidence of SSI were retrospectively analyzed in 1449 pediatric patients who underwent primary definitive fusion surgery for spinal deformity at any of 15 institutions from 2015 to 2017. SSI was defined according to the US Centers for Disease Control and Prevention guideline. The incidence of all SSIs was 1.4% and that of deep SSIs was 0.76%. The most common pathogenic microbes were methicillin-resistant staphylococci (n = 5) followed by gram-negative rods (n = 4), methicillin-sensitive staphylococci (n = 1), and others (n = 10). In univariate analysis, younger age, male sex, a diagnosis of kyphosis, type of scoliosis, American Society of Anesthesiologists (ASA) class ≥3, mental retardation urinary incontinence, combined anterior-posterior fusion, greater magnitude of kyphosis, three-column osteotomy, use of blood transfusion, and number of antibiotic administration were associated with the likelihood of SSI (all P < 0.05). Multivariate logistic regression analysis identified the following independent risk factors for SSI: syndromic scoliosis etiology (vs. idiopathic scoliosis; adjusted odds ratio [OR] 16.106; 95% confidence interval [CI] 2.225-116.602), neuromuscular scoliosis etiology (vs. idiopathic scoliosis; adjusted OR 11.814; 95% CI 1.109-125.805), ASA class 3 (vs. class 2; adjusted OR 15.231; 95% CI 1.201-193.178), and administration of antibiotic therapy twice daily (vs. three times daily; adjusted OR 6.121; 95% CI 1.261-29.718). The overall infection rate was low. The most common causative bacteria were methicillin-resistant followed by gram-negative rods. Independent risk factors for SSI in pediatric patients undergoing spinal deformity surgery were scoliosis etiology, ASA class 3, and administration of antibiotic therapy twice daily.Level of Evidence: 3.
Sections du résumé
STUDY DESIGN
METHODS
A retrospective multicenter study.
OBJECTIVE
OBJECTIVE
To determine the surgical site infection (SSI) rate, associated risk factors, and causative pathogens in pediatric patients with spinal deformity.
SUMMARY OF BACKGROUND DATA
BACKGROUND
There have been no extensive investigations of the risk factors for SSI in Japan.
METHODS
METHODS
Demographic data, radiographic findings, and the incidence of SSI were retrospectively analyzed in 1449 pediatric patients who underwent primary definitive fusion surgery for spinal deformity at any of 15 institutions from 2015 to 2017. SSI was defined according to the US Centers for Disease Control and Prevention guideline.
RESULTS
RESULTS
The incidence of all SSIs was 1.4% and that of deep SSIs was 0.76%. The most common pathogenic microbes were methicillin-resistant staphylococci (n = 5) followed by gram-negative rods (n = 4), methicillin-sensitive staphylococci (n = 1), and others (n = 10). In univariate analysis, younger age, male sex, a diagnosis of kyphosis, type of scoliosis, American Society of Anesthesiologists (ASA) class ≥3, mental retardation urinary incontinence, combined anterior-posterior fusion, greater magnitude of kyphosis, three-column osteotomy, use of blood transfusion, and number of antibiotic administration were associated with the likelihood of SSI (all P < 0.05). Multivariate logistic regression analysis identified the following independent risk factors for SSI: syndromic scoliosis etiology (vs. idiopathic scoliosis; adjusted odds ratio [OR] 16.106; 95% confidence interval [CI] 2.225-116.602), neuromuscular scoliosis etiology (vs. idiopathic scoliosis; adjusted OR 11.814; 95% CI 1.109-125.805), ASA class 3 (vs. class 2; adjusted OR 15.231; 95% CI 1.201-193.178), and administration of antibiotic therapy twice daily (vs. three times daily; adjusted OR 6.121; 95% CI 1.261-29.718).
CONCLUSION
CONCLUSIONS
The overall infection rate was low. The most common causative bacteria were methicillin-resistant followed by gram-negative rods. Independent risk factors for SSI in pediatric patients undergoing spinal deformity surgery were scoliosis etiology, ASA class 3, and administration of antibiotic therapy twice daily.Level of Evidence: 3.
Identifiants
pubmed: 33496537
doi: 10.1097/BRS.0000000000003960
pii: 00007632-202108150-00010
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1097-1104Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Références
Hart RA, Cabalo A, Bess S, et al. International Spine Study Group. Comparison of patient and surgeon perceptions of adverse events after adult spinal deformity surgery. Spine (Phila Pa 1976) 2013; 38:732–736.
Gum JL, Carreon LY, Stimac JD, et al. Predictors of Oswestry disability index worsening after lumbar fusion. Orthopedics 2013; 36:e478–e483.
Ballard MR, Miller NH, Nyquist AC, et al. A multidisciplinary approach improves infection rates in pediatric spine surgery. J Pediatr Orthop 2012; 32:266–270.
Whitehouse JD, Friedman ND, Kirkland KB, et al. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 2002; 23:183–189.
Hedequist D, Haugen A, Hresko T, et al. Failure of attempted implant retention in spinal deformity delayed surgical site infections. Spine (Phila Pa 1976) 2009; 34:60–64.
Burton DC, Carlson BB, Place HM, et al. Results of the Scoliosis Research Society Morbidity and Mortality Database 2009-2012: a report from the morbidity and mortality committee. Spine Deform 2016; 4:338–343.
Sugawara R, Takeshita KY, Arai Y, et al. The Japanese Scoliosis Society morbidity and mortality survey in 2014: the complication trends of spinal deformity surgery from 2012 to 2014. Spine Surg Relat Res 2018; 3:214–221.
Glotzbecker MP, Riedel MD, Vitale MG, et al. What's the evidence? Systematic literature review of risk factors and preventive strategies for surgical site infection following pediatric spine surgery. J Pediatr Orthop 2013; 33:479–487.
Meng F, Cao J, Meng X. Risk factors for surgical site infection following pediatric spinal deformity surgery: a systematic review and meta-analysis. Childs Nerv Syst 2015; 31:521–527.
Subramanyam R, Schaffzin J, Cudilo EM, et al. Systematic review of risk factors for surgical site infection in pediatric scoliosis surgery. Spine J 2015; 15:1422–1431.
Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection,2017. JAMA Surg 2017; 52:784–791.
Cahill PJ, Warnick DE, Lee MJ, et al. Infection after spinal fusion for pediatric spinal deformity: thirty years of experience at a single institution. Spine (Phila Pa 1976) 2010; 35:1211–1217.
Ho C, Skaggs DL, Weiss JM, et al. Management of infection after instrumented posterior spine fusion in pediatric scoliosis. Spine (Phila Pa 1976) 2007; 32:2739–2744.
Mackenzie WG, Matsumoto H, Williams BA, et al. Surgical site infection following spinal instrumentation for scoliosis: a multicenter analysis of rates, risk factors, and pathogens. J Bone Joint Surg Am 2013; 95:800–806.
Milstone AM, Maragakis LL, Townsend T, et al. Timing of preoperative antibiotic prophylaxis: a modifiable risk factor for deep surgical site infections after pediatric spinal fusion. Pediatr Infect Dis J 2008; 27:704–708.
Pourtaheri S, Miller F, Dabney K, et al. Deep wound infections after pediatric scoliosis surgery. Spinal Deform 2015; 3:533–540.
Sullivan BT, Abousamra O, Puvanesarajah V, et al. Deep infections after pediatric spinal arthrodesis: differences exist with idiopathic, neuromuscular, or genetic and syndromic cause of deformity. J Bone Joint Surg Am 2019; 101:2219–2225.
Linam WM, Margolis P, Staat MA, et al. Risk factors associated with surgical site infection after pediatric posterior spinal fusion procedure. Infect Control Hosp Epidemiol 2009; 30:109–116.
Dhawale AA, Shah SA, Sponseller PD, et al. Are antifibrinolytics helpful in decreasing blood loss and transfusions during spinal fusion surgery in children with cerebral palsy scoliosis? Spine (Phila Pa 1976) 2012; 37:E549–E555.
Mauermann WJ, Nemergut EC. The anesthesiologist's role in the prevention of surgical site infections. Anesthesiology 2006; 105:413–421.
Hatlen T, Song K, Shurtleff D, et al. Contributory factors to postoperative spinal fusion complications for children with myelomeningocele. Spine (Phila Pa 1976) 2010; 35:1294–1299.
Geiger F, Parsch D, Carstens C. Complications of scoliosis surgery in children with myelomeningocele. Eur Spine J 1999; 8:22–26.
Ho C, Sucato DJ, Richards BS. Risk factors for the development of delayed infections following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis patients. Spine (Phila Pa 1976) 2007; 32:2272–2277.
Labbe AC, Demers AM, Rodrigues R, et al. Surgical-site infection following spinal fusion: a case-control study in a children's hospital. Infect Control Hosp Epidemiol 2003; 24:591–595.
Salsgiver E, Crotty J, LaRussa SJ, et al. Surgical site infections following spine surgery for non-idiopathic scoliosis. J Pediatr Orthop 2017; 37:e476–e483.
Steinberg JP, Braun BI, Hellinger WC, et al. Trial to Reduce Antimicrobial Prophylaxis Errors (TRAPE) Study Group. Timing of antimicrobial prophylaxis and the risk of surgical site infections: results from the trial to reduce antimicrobial prophylaxis errors. Ann Surg 2009; 250:10–16.
Blank J, Flynn JM, Bronson W, et al. The use of postoperative subcutaneous closed suction drainage after posterior spinal fusion in adolescents with idiopathic scoliosis. J Spinal Disorder Tech 2003; 16:508–512.
Sponseller PD, LaPorte DM, Hungerford MW, et al. Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes. Spine (Phila Pa 1976) 2000; 25:2461–2466.
Devin CJ, Chotai S, McGirt MJ, et al. Intrawound vancomycin decreases the risk of surgical site infection after posterior spine surgery: a multicenter analysis. Spine (Phila Pa 1976) 2018; 43:65–71.
Vitale MG, Riedel MD, Glotzbecker MP, et al. Building consensus: development of a Best Practice Guideline (BPG) for surgical site infection (SSI) prevention in high-risk pediatric spine surgery. J Pediatr Orthop 2013; 33:471–478.
Garg S, Bloch N, Potter M, et al. Topical vancomycin in pediatric spine surgery does not reduce surgical site infection: a retrospective cohort study. Spine Deform 2018; 6:523–528.
Glotzbecker MP, St Hilaire TA, Pawelek JB, et al. Children's Spine Study Group; Growing Spine Study Group. Best practice guidelines for surgical site infection prevention with surgical treatment of early onset scoliosis. J Pediatr Orthop 2019; 39:e602–e607.
Kirzner N, Hilliard L, Martin C, et al. Bone graft in posterior spine fusion for adolescent idiopathic scoliosis: a meta-analysis. ANZ J Surg 2018; 88:1247–1252.
Theologis AA, Tabaraee E, Lin T, et al. Type of bone graft or substitute does not affect outcome of spine fusion with instrumentation for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2015; 40:1345–1351.