Preoperative warming and undesired surgical and anesthesia outcomes in pediatric spinal surgery—a retrospective cohort study

Görges, Matthias; West, Nicholas; Cheung, Wesley; Zhou, Guohai; Miyanji, Firoz; Whyte, Simon

doi:10.1111/pan.12939

Cited by 21 publications

(11 citation statements)

References 16 publications

(21 reference statements)

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“…Normothermia may therefore reduce operative blood loss. 32,33 Optimizing patients with neuromuscular conditions includes addressing aspects such as skin care and nutrition. This is beyond the scope of this work.…”

Section: Discussionmentioning

confidence: 99%

Reducing Surgical Site Infection in Pediatric Scoliosis Surgery: A Multidisciplinary Improvement Program and Prospective 4-Year Audit

Tipper

Chiwera

Lucas

2019

Global Spine Journal

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Study Design: Single-center prospective cohort. Objectives: To evaluate a multidisciplinary led, structured protocol for reducing surgical site infections (SSIs) in pediatric scoliosis surgery. Methods: Following a spike to 8.6% in local annual infection rate, a multidisciplinary team was convened to identify interventions. The team consisted of spinal surgeons, infectious diseases consultants, physiotherapists, specialist nurses, and theatre managers. A protocol was initiated, including preoperative skin decontamination; standardized operative site prepreparation; betadine-soaked swabs sutured to wound edges; blood loss minimization; 3 L0.9% saline pulsed-lavage; defined protocol of glove changes; antibiotic regime of preoperative gentamicin, intraoperative subfascial vancomycin powder, 48-hour cefuroxime; and intraoperative normothermia. A 4-year audit was initiated of all patients aged ≤18 years undergoing corrective spinal deformity surgery. Institutional board review was not required. Results: Between January 1, 2014 and January 1, 2018, 414 operations were performed on 355 patients: male:female = 1:2.2, mean age 13.7 years (range 2.5-17.9), 233 idiopathic (mean operated vertebral levels 12), 122 neuromuscular (mean operated vertebral levels 14), 66 growing rod procedures, 41 multistage procedures. The mean number of operated vertebral levels both overall and in infected cases was 13 (range 2-17). Nine SSIs occurred in 8 patients at 3 months (4 neuromuscular), resulting in an overall SSI per operation of 2.2%. Conclusion: A multidisciplinary approach with standardized measures significantly reduced SSIs in the unit’s pediatric scoliosis surgery.

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Section: Discussionmentioning

confidence: 99%

Reducing Surgical Site Infection in Pediatric Scoliosis Surgery: A Multidisciplinary Improvement Program and Prospective 4-Year Audit

Tipper

Chiwera

Lucas

2019

Global Spine Journal

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“…18 It was also associated with a reduction in the number of allogenic blood transfusions. 24 Prewarming alone, however, does not prevent hypothermia. To decrease the incidence of intraoperative hypothermia effectively in all patients, additional measures are required, including forced air warming, fluid warming, or increasing the operating room temperature.…”

Section: Warming Feedback Effectsmentioning

confidence: 99%

Using physiological monitoring data for performance feedback: an initiative using thermoregulation metrics

Görges

West

Whyte

2016

Can J Anesth/J Can Anesth

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“…The duration of prewarming was 72 ± 26 min with, thereafter, smaller decreases in core temperature throughout the procedure and fewer patients experiencing intraoperative hypothermia. More recently, a retrospective cohort study of 334 pediatric spine deformity surgery procedures was reported by Gorges et al 54 who found that prewarming was associated with reduction in the need for transfusion, although not with the incidence of SSI. Further, the ideal temperature to which warming should be targeted remains uncertain, with new preclinical data suggesting that following hypothermia, in Vitro macrophages do not normalize function upon warming to 37…”

Section: Preoperative Warmingmentioning

confidence: 99%

Prevention of Surgical Site Infection in Spine Surgery

et al. 2017

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BACKGROUND: Spine surgery is complicated by an incidence of 1% to 9% of surgical site infection (SSI). The most common organisms are gram-positive bacteria and are endogenous, that is are brought to the hospital by the patient. Efforts to improve safety have been focused on reducing SSI using a bundle approach. The bundle approach applies many quality improvement efforts and has been shown to reduce SSI in other surgical procedures. OBJECTIVE: To provide a narrative review of practical solutions to reduce SSI in spine surgery. METHODS: Literature review and synthesis to identify methods that can be used to prevent SSI. RESULTS: SSI prevention starts with proper patient selection and optimization of medical conditions, particularly reducing smoking and glycemic control. Screening for staphylococcus organisms and subsequent decolonization is a promising method to reduce endogenous bacterial burden. Preoperative warming of patients and timely administration of antibiotics are critical to prevent SSI. Skin preparation using chlorhexidine and alcohol solutions are recommended. Meticulous surgical technique and maintenance of sterile techniques should always be performed. Postoperatively, traditional methods of tissue oxygenation and glycemic control remain essential. Newer wound care methods such as silver impregnation dressing and wound-assisted vacuum dressing are encouraging but need further investigation. CONCLUSION: Significant reduction of SSIs is possible, but requires a systems approach involving all stakeholders. There are many simple and low-cost components that can be adjusted to reduce SSIs. Systematic efforts including understanding of pathophysiology, prevention strategies, and system-wide quality improvement programs demonstrate significant reduction of SSI.

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Preoperative warming and undesired surgical and anesthesia outcomes in pediatric spinal surgery—a retrospective cohort study

Cited by 21 publications

References 16 publications

Reducing Surgical Site Infection in Pediatric Scoliosis Surgery: A Multidisciplinary Improvement Program and Prospective 4-Year Audit

Reducing Surgical Site Infection in Pediatric Scoliosis Surgery: A Multidisciplinary Improvement Program and Prospective 4-Year Audit

Using physiological monitoring data for performance feedback: an initiative using thermoregulation metrics

Prevention of Surgical Site Infection in Spine Surgery

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