A novel risk calculator predicting surgical site infection after spinal surgery in patients with cerebral palsy

Abstract

Surgical site infection (SSI) after pediatric spine surgery is a well-recognized complication. Since the year 2000, the reported risk of SSI in pediatric spine surgery ranges from 0% to 26.3% in the USA. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Most of these studies have found that patients with non-idiopathic deformities, including cerebral palsy (CP), are at increased risk of SSI compared with those with idiopathic etiologies. 1,3,4,16 Treatment of SSI entails surgical irrigation and debridement of the wound (often multiple), long-term antibiotic treatment/suppression, and possibly implant removal or revision. This all results in a substantial burden to patients, families, physicians, hospitals, and payers. 19,20 While the literature documents multiple

Updating the Evidence: Systematic Literature Review of Risk Factors and Strategies for Prevention, Diagnosis, and Treatment of Surgical Site Infection After Pediatric Scoliosis Surgery

“…In a study of pediatric CP patients undergoing spinal fusion, a final SSI risk prediction model included behavioral disorder/delay as a risk factor. 18 Conclusions: There is grade B evidence that baseline cognitive/behavioral impairments are associated with an increased risk of SSI after NMS surgery in pediatric populations, although this is likely confounded by underlying etiology.…”

“…Two Level III studies identified baseline urinary/ bowel incontinence as a risk factor for postoperative SSI among CP-scoliosis or any NMS patients, with odds ratios of 2.5 and 2.4, respectively. 18,50 Conclusions: There is grade B evidence that urinary/ bowel incontinence is associated with greater risk of SSI after NMS surgery in pediatric populations.…”

“…48 Only, 1 study reported that BMI was not independently associated with infection risk among AIS patients. 51 8,18,19 Idiopathic, NMS, syndromic, congenital Pulmonary comorbidities 20,21 NMS GERD 22 NMS Preoperative WBC count 23 NMS Preoperative urine cultures 24 NMS Postoperative weight gain/loss 20 NMS Preoperative lumbar kyphosis 25 NMS Lenke curve classification 26 AIS Rod construct type 27,28 EOS, NMS Operative duration 29 Idiopathic, NMS, syndromic, congenital 2 Prevention Insufficient Preoperative Staphylococcus aureus nasal swabs and subsequent decolonization 30 AIS Preoperative MRSA screening and modification of antibiotic regimen 31 Idiopathic, NMS, syndromic, congenital Intraoperative redosing of IV antibiotics 32 Idiopathic, NMS, syndromic, congenital Type of cephalosporin for intraoperative administration 33 AIS Povidone-iodine irrigation alone (without intrawound vancomycin powder) 34 AIS Continued postoperative antibiotic prophylaxis 35,36 Idiopathic, NMS, syndromic, congenital Prophylactic hyperbaric oxygen therapy 37 NMS Plastic multilayered closure 38 or offset layered closure 39 EOS, NMS, syndromic, congenital Conclusions: There is grade B evidence that increased BMI is associated with greater risk of SSI after scoliosis surgery in pediatric populations.…”

“…8,18,19 Glotzbecker et al reported that older patients were more likely to present with recurrent infection requiring I&D within 3 months of PSF, 8 whereas Matsumoto et al reported that age <12 years was an independent predictor of 90-day SSI among pediatric CP patients undergoing spinal fusion. 18 McLeod et al found no association with age among myelodysplasia patients. 19 Conclusions: There is insufficient and conflicting evidence regarding the association between patient age and risk of SSI after scoliosis surgery in pediatric populations.…”

“…Four Level III studies reported that nonambulatory status at baseline was associated with increased risk of acute SSI after scoliosis surgery. 18,29,52,53 Of these, 1 study analyzed only CP patients 18…”