A Multidisciplinary Approach Improves Infection Rates In Pediatric Spine Surgery

Ballard, Michael R.; Miller, Nancy H.; Nyquist, Ann‐Christine; Elise, Benefield; Baulesh, David M.; Erickson, Mark

doi:10.1097/bpo.0b013e31824b29c1

Cited by 48 publications

(31 citation statements)

References 16 publications

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“…Several hospitals conduct root-cause analyses with a multidisciplinary team to identify the cause of the issues and any lack of adherence in the evidence-based practices. 149,202-204 …”

Section: Section 6 : Examples Of Implementations Trategiesmentioning

confidence: 99%

Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update

Anderson

Podgorny

Berríos-Torres

et al. 2014

Infect. Control Hosp. Epidemiol.

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806

447

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PURPOSE Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their surgical site infection (SSI) prevention efforts. This document updates “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals,”1 published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.2

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“…Several hospitals conduct root-cause analyses with a multidisciplinary team to identify the cause of the issues and any lack of adherence in the evidence-based practices. 149,202-204 …”

Section: Section 6 : Examples Of Implementations Trategiesmentioning

confidence: 99%

Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update

Anderson

Podgorny

Berríos-Torres

et al. 2014

Infect. Control Hosp. Epidemiol.

Self Cite

806

447

View full text Add to dashboard Cite

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“…11,32 Institutional standardized protocols can reduce the relative risk of infections by 50%. 1,11 This is a volume-reinforced pattern involving multiple personnel and including such varied components as preadmission bathing, nutrition control, prophylactic antibiotic dosing, operating room traffic, and postoperative wound management. 11 Vitale et al recommend a 14-point best-practice guideline for reducing infections for high-risk pediatric spinal surgery.…”

Section: Improving Clinical Outcomes: Impact Of Volume On Outcomesmentioning

confidence: 99%

Adolescent idiopathic scoliosis: risk factors for complications and the effect of hospital volume on outcomes

Menger

Kalakoti

Pugely

et al. 2017

Neurosurgical Focus

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OBJECTIVEAdolescent idiopathic scoliosis (AIS) is the most common form of scoliosis. Limited literature exists defining risk factors associated with outcomes during initial hospitalization in these patients. In this study, the authors investigated patient demographics, clinical and hospital characteristics impacting short-term outcomes, and costs in adolescent patients undergoing surgical deformity correction for idiopathic scoliosis. Additionally, the authors elucidate the impact of hospital surgical volume on outcomes for these patients.METHODSUsing the National Inpatient Sample database and appropriate International Classification of Diseases, 9th Revision codes, the authors identified adolescent patients (10–19 years of age) undergoing surgical deformity correction for idiopathic scoliosis during 2001–2014. For national estimates, appropriate weights provided by the Agency of Healthcare Research and Quality were used. Multivariable regression techniques were employed to assess the association of risk factors with discharge disposition, postsurgical neurological complications, length of hospital stay, and hospitalization costs.RESULTSOverall, 75,106 adolescent patients underwent surgical deformity correction. The rates of postsurgical complications were estimated at 0.9% for neurological issues, 2.8% for respiratory complications, 0.8% for cardiac complications, 0.4% for infections, 2.7% for gastrointestinal complications, 0.1% for venous thromboembolic events, and 0.1% for acute renal failure. Overall, patients stayed at the hospital for an average of 5.72 days (median 5 days) and on average incurred hospitalization costs estimated at $54,997 (median $47,909). As compared with patients at low-volume centers (≤ 50 operations/year), those undergoing surgical deformity correction at high-volume centers (> 50/year) had a significantly lower likelihood of an unfavorable discharge (discharge to rehabilitation) (OR 1.16, 95% CI 1.03–1.30, p = 0.016) and incurred lower costs (mean $33,462 vs $56,436, p < 0.001) but had a longer duration of stay (mean 6 vs 5.65 days, p = 0.002). In terms of neurological complications, no significant differences in the odds ratios were noted between high- and low-volume centers (OR 1.23, 95% CI 0.97–1.55, p = 0.091).CONCLUSIONSThis study provides insight into the clinical characteristics of AIS patients and their postoperative outcomes following deformity correction as they relate to hospital volume. It provides information regarding independent risk factors for unfavorable discharge and neurological complications following surgery for AIS. The proposed estimates could be used as an adjunct to clinical judgment in presurgical planning, risk stratification, and cost containment.

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“…It is widely recognized that the risk of SSI can be reduced with the coordinated efforts of a multidisciplinary team. [13, 15, 19] Compliance with an institution's perioperative antibiotic prophylaxis bundle is one modifiable risk factor that can minimize the risk for SSI. Previous reports have detailed the challenges associated with antimicrobial SSI prophylaxis, including selection of the appropriate antibiotic, timely preoperative dosing, intraoperative re-dosing, and postoperative antibiotic administration.…”

Section: Discussionmentioning

confidence: 99%

“…[13] The purpose of this study was to evaluate how compliance with the TZ perioperative antibiotic protocol impacted infection rates in both low risk (LR) and high risk (HR) patients undergoing spinal surgery at a tertiary pediatric hospital. We hypothesized that compliance with the antibiotic protocol would lead to reduced SSI in pediatric patients undergoing spine surgery.…”

Section: Introductionmentioning

confidence: 99%

Compliance With a Comprehensive Antibiotic Protocol Improves Infection Incidence in Pediatric Spine Surgery

Vandenberg¹,

Niswander

Carry

et al. 2018

Journal of Pediatric Orthopaedics

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Background A multidisciplinary task force, designated Target Zero (TZ), has developed protocols for prevention of surgical site infection (SSI) for spine surgery at our institution. The purpose of this study was to evaluate how compliance with an antibiotic bundle impacts infection incidences in pediatric spine surgery. Methods After institutional review board approval, a consecutive series of 511 patients (517 procedures) who underwent primary spine procedures from 2008-2012 were retrospectively reviewed to identify patients who developed SSI. Patients were followed for a minimum of 90 days postoperatively. Compliance data was collected prospectively in 511 consecutive patients and a total of 517 procedures. Three criteria were required for antibiotic bundle compliance: appropriate antibiotics completely administered within one hour prior to incision, antibiotics appropriately re-dosed intraoperatively for blood loss and time, and antibiotics discontinued within 24 hours postoperatively. A multivariable logistic regression analysis was used to test the association between compliance and the development of an infection. Results Overall antibiotic bundle compliance rate was 85%. After adjusting for risk category, estimated blood loss, and study year, the likelihood of an infection was increased in the non-compliant group compared to the compliant group [adjusted odds ratio: 3.0, 95% CI: 0.96 to 9.47, p = 0.0587]. When expressed as the Number Needed to Treat (NNT), strict adherence to antibiotic bundle compliance prevented one SSI within 90 days of surgery for every 26 patients treated with the antibiotic bundle. Reasons for non-compliance included failure to infuse preoperative antibiotics one hour prior to incision (10.3%), failure to re-dose antibiotics intraoperatively based on time or blood loss (5.5%), and failure to discontinue antibiotics within 24 hours postoperatively (1.9%). Conclusions Compliance with a comprehensive antibiotic protocol can lead to meaningful reductions in surgical site infection (SSI) incidences in pediatric spine surgery. Institutions should focus on improving compliance with prophylactic antibiotic protocols to decrease SSI in pediatric spine surgery. Level of Evidence Retrospective cohort study, Level III

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A Multidisciplinary Approach Improves Infection Rates In Pediatric Spine Surgery

Cited by 48 publications

References 16 publications

Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update

Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update

Adolescent idiopathic scoliosis: risk factors for complications and the effect of hospital volume on outcomes

Compliance With a Comprehensive Antibiotic Protocol Improves Infection Incidence in Pediatric Spine Surgery

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