Deep Surgical Site Infection Following 2344 Growing-Rod Procedures for Early-Onset Scoliosis

Kabirian, Nima; Akbarnia, Behrooz A.; Pawelek, Jeff; Alam, Md. Aftab; Mundis, Gregory M.; Acácio, Ricardo; Thompson, George H.; Marks, David; Gardner, Adrian; Sponseller, Paul D.; Skaggs, David L.

doi:10.2106/jbjs.m.00618

Cited by 101 publications

(63 citation statements)

References 22 publications

(17 reference statements)

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“…The pooled average SSI rate was calculated to be 1.6% (median, 2.8%; range, 0.2%–18.3%) based on 64 cohorts comprising a total of 212,639 patients. Patients who underwent instrumented spinal fusion procedures were evaluated for SSIs in 35 identified studies [6,12,25,28,35,37,39,48,50,61,67,74,77,78,84,85,90,93,97,98,101,112,121,122,126,127,132,134,135,137,148,154,156,160,174]. The pooled average SSI rate was calculated to be 3.8% (median, 4.2%; range, 0.4%–20%) based on 39 cohorts with a total of 28,628 patients.…”

Section: Resultsmentioning

confidence: 99%

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Patel¹,

Khoury²,

Girgenti

et al. 2017

Surgical Infections

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Background: Spine operations may be indicated for treatment of diseases including vertebral injuries, degenerative spinal conditions, disk disease, spinal misalignments, or malformations. Surgical site infection (SSI) is a clinically important complication of spine surgery. Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), is a leading cause of post-spinal SSIs.Methods: PubMed and applicable infectious disease conference proceedings were searched to identify relevant published studies. Overall, 343 full-text publications were screened for epidemiologic, mortality, health care resource utilization, and cost data on SSIs associated with specified spine operations.Results: Surgical site infection rates were identified in 161 studies from North America, Europe, and Asia. Pooled average SSI and S. aureus SSI rates for spine surgery were 1.9% (median, 3.3%; range, 0.1%–22.6%) and 1.0% (median, 2.0%; range, 0.02%–10.0%). Pooled average contribution of S. aureus infections to spinal SSIs was 49.3% (median, 50.0%; range, 16.7%–100%). Pooled average proportion of S. aureus SSIs attributable to MRSA was 37.9% (median, 42.5%; range, 0%–100%). Instrumented spinal fusion had the highest pooled average SSI rate (3.8%), followed by spinal decompression (1.8%) and spinal fusion (1.6%). The SSI-related mortality rate among spine surgical patients ranged from 1.1%–2.3% (three studies). All studies comparing SSI and control cohorts reported longer hospital stays for patients with SSIs. Pooled average SSI-associated re-admission rate occurring within 30 d from discharge ranged from 20% to 100% (four studies). Pooled average SSI-related re-operation rate was 67.1% (median, 100%; range, 33.5%–100%). According to two studies reporting direct costs, spine surgical patients incur approximately double the health care costs when they develop an SSI.Conclusions: Available published studies demonstrate a clinically important burden of SSIs related to spine operations and the substantial contribution of S. aureus (including MRSA). Preventive strategies aimed specifically at S. aureus SSIs could reduce health care costs and improve patient outcomes for spine operations.

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Section: Resultsmentioning

confidence: 99%

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Patel¹,

Khoury²,

Girgenti

et al. 2017

Surgical Infections

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“…29,30,[38][39][40][41][42][43] Implant complications such as anchor malfunction (pullout from the spine, erosion through the rib) and rod breakage are common (Fig 9). Distraction-based posterior implants often produce kyphosis, which may result in an unfavorable overall sagittal plane balance.…”

Section: Complications Of Distraction-based Implantsmentioning

confidence: 99%

“…Each lengthening surgery has been shown to increase the risk of deep infection 3.3 times in EOS. 41 The length gained from serial lengthening has also been shown to follow a law of diminishing returns, with decreased spinal length gained after each lengthening because of increased stiffness of the spine. 45,46 Autofusion of the spine has been also described after repeated lengthenings.…”

Section: Complications Of Distraction-based Implantsmentioning

confidence: 99%

Early-Onset Scoliosis: A Review of History, Current Treatment, and Future Directions

et al. 2016

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Early-onset scoliosis (EOS) is defined as curvature of the spine in children >10° with onset before age 10 years. Young children with EOS are at risk for impaired pulmonary function because of the high risk of progressive spinal deformity and thoracic constraints during a critical time of lung development. The treatment of EOS is very challenging because the population is inhomogeneous, often medically complex, and often needs multiple surgeries. In the past, early spinal fusion was performed in children with severe progressive EOS, which corrected scoliosis but limited spine and thoracic growth and resulted in poor pulmonary outcomes. The current goal in treatment of EOS is to maximize growth of the spine and thorax by controlling the spinal deformity, with the aim of promoting normal lung development and pulmonary function. Bracing and casting may improve on the natural history of progression of spinal deformity and are often used to delay surgical intervention or in some cases obviate surgery. Recent advances in surgical implants and techniques have led to the development of growth-friendly implants, which have replaced early spine fusion as the surgical treatment of choice. Treatment with growth-friendly implants usually requires multiple surgeries and is associated with frequent complications. However, growth-friendly spine surgery has been shown to correct spinal deformity while allowing growth of the spine and subsequently lung growth.

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“…Neuromuscular scoliosis is associated with urinary and bowel incontinence, which has been shown to be a risk factor for infection in spinal deformity surgery [4] as gastrointestinal tract flora can colonize wounds [10]. Additional risk factors elucidated for GR include nonambulatory status, need for revision surgeries, and stainless-steel implants instead of titanium or chromium-cobalt [11].…”

Section: Discussionmentioning

confidence: 99%

Offset layered closure reduces deep wound infection in early-onset scoliosis surgery

Grzywna

Miller

Glotzbecker

et al. 2016

Journal of Pediatric Orthopaedics B

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Deep wound infection is a common complication in early-onset scoliosis (EOS) surgery. Soft tissue technique has received less attention as a means to reduce infection. A retrospective review of 1170 EOS surgeries (single surgeon, institution) investigated the impact of offset layered closure (OLC) and soft tissue awareness. The introduction of OLC reduced deep infection from 3.0% in 99 surgeries to 0.37% in 1071. Logistic regression confirmed that OLC led to significantly lower odds of infection (P=0.007). This deep infection rate (0.37%) is more typical of elective surgery, providing a more optimistic view of infection in EOS surgery than generally reported.

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Deep Surgical Site Infection Following 2344 Growing-Rod Procedures for Early-Onset Scoliosis

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 101 publications

References 22 publications

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Early-Onset Scoliosis: A Review of History, Current Treatment, and Future Directions

Offset layered closure reduces deep wound infection in early-onset scoliosis surgery

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