Risk Factors for Early Infection in Pediatric Spinal Deformity Surgery: A Multivariate Analysis

Du, Jerry Y.; Poe-Kochert, Connie; Thompson, George H.; Son-Hing, Jochen P.; Hardesty, Christina K.; Mistovich, R. Justin

doi:10.1016/j.jspd.2018.09.011

Cited by 11 publications

(11 citation statements)

References 24 publications

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“…In this study, delayed SSI was specified as an infection occurred beyond 3 months after the initial procedure. 17,19…”

Section: Methodsmentioning

confidence: 99%

“…A deep SSI was defined following the Center for Disease Control and Prevention criteria as an infection involving the fascial and muscle layers. 19 The deep SSI was diagnosed when patients had at least one of the following. [19][20][21][22] (1) purulent drainage from the deep incision; (2) a deep incision that spontaneously dehisces, or is deliberately opened or aspirated by a surgeon AND organism(s) identified from the deep soft tissues of the incision by a culture or non-culture based microbiologic testing method which is performed for purposes of clinical diagnosis or treatment AND patient has at least one of the following clinical symptoms: fever (>38 C); local pain or tenderness; (3) gross anatomical or histopathologic exam, or imaging test showed that an abscess or other evidence of infection involving deep wound.…”

Section: Diagnosis Of Deep Ssimentioning

confidence: 99%

“…In this study, delayed SSI was specified as an infection occurred beyond 3 months after the initial procedure. 17,19 Treatment Protocol As soon as deep SSI was diagnosed, an immediate debridement with irrigation was performed. The infected surgical site was approached through the same incision used in the initial procedure.…”

Section: Diagnosis Of Deep Ssimentioning

confidence: 99%

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Incidence, Management and Outcome of Delayed Deep Surgical Site Infection Following Spinal Deformity Surgery: 20-Year Experience at a Single Institution

Wang

Yang

et al. 2020

Global Spine Journal

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Study Design: A retrospective study. Objectives: To investigate the incidence, management and outcome of delayed deep surgical site infection (SSI) after the spinal deformity surgery. Methods: This study reviewed 5044 consecutive patients who underwent spinal deformity corrective surgery and had been followed over 2 years. Delayed deep SSI were defined as infection involving fascia and muscle and occurring >3 months after the initial procedure. An attempt to retain the implant were initially made for all patients. If the infection failed to be eradicated, the implant removal should be put off until solid fusion was confirmed, usually more than 2 years after the initial surgery. Radiographic data at latest follow-up were compared versus that before implant removal. Results: With an average follow-up of 5.3 years, 56 (1.1%) patients were diagnosed as delayed deep SSI. Seven (12.5%) patients successfully retained instrumentation and there were no signs of recurrence during follow-up (average 3.4 years). The remaining patients, because of persistent or recurrent infection, underwent implant removal 2 years or beyond after the primary surgery, and solid fusion was detected in any case. However, at a minimum 1-year follow-up (average 3.9 years), an average loss of 9° in the thoracic curve and 8° in the thoracolumbar/lumbar curves was still observed. Conclusions: Delayed deep SSI was rare after spinal deformity surgery. To eradicate infection, complete removal of implant may be required in the majority of delayed SSI. Surgeons must be aware of high likelihood of deformity progression after implant removal, despite radiographic solid fusion.

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“…In this study, delayed SSI was specified as an infection occurred beyond 3 months after the initial procedure. 17,19…”

Section: Methodsmentioning

confidence: 99%

Section: Diagnosis Of Deep Ssimentioning

confidence: 99%

See 1 more Smart Citation

Incidence, Management and Outcome of Delayed Deep Surgical Site Infection Following Spinal Deformity Surgery: 20-Year Experience at a Single Institution

Wang

Yang

et al. 2020

Global Spine Journal

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“…Incidence of SSI: the patients' age, sex, smoking and drinking behavior, previous surgical history, primary disease, and concomitant disease; intraoperative conditions: number of fenestrations, number of discectomy, number of fixed segments, operation time, blood loss, blood transfusion, and dural rupture; and postoperative infection time, symptoms, inflammatory indicators, pathogenic bacteria, and treatment. Infection that occurred within 3 months after lumbar Dynesys dynamic internal fixation was defined as an early infection, and infection that occurred 3 months after lumbar Dynesys dynamic internal fixation was defined as a delayed infection [ 18 , 19 ]. The infected cases were divided into two groups, namely, the early infection group and delayed infection group, referred to as Groups A and B, respectively.…”

Section: Methodsmentioning

confidence: 99%

Postoperative Management Strategy of Surgical Site Infection following Lumbar Dynesys Dynamic Internal Fixation

Liu

Luo

Zhao

et al. 2021

Pain Research and Management

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Aim. To research the incidence of surgical site infection (SSI) following lumbar Dynesys dynamic internal fixation and its management strategy. Methods. We retrospectively analyzed all cases of lumbar Dynesys dynamic internal fixation performed from January 2010 to December 2019, and the data from patients with SSI were collected. The observational indicators included the incidence of SSI, general information of the patients, surgical details, inflammatory indicators, pathogenic bacteria, and treatment. SSI was defined as both early infection and delayed infection, and the cases were divided into Groups A and B, respectively. The relevant indicators and treatment were compared between the two groups. Results. A total of 1125 cases of lumbar Dynesys dynamic internal fixation were followed up. Twenty-five cases of SSI occurred, and the incidence of SSI was 2.22% (25/1125). There were 14 cases of early infection (1.24%) and 11 cases of delayed infection (0.98%). Fourteen cases of early infection occurred 12.3 ± 8.3 days postoperatively (3–30), and 11 cases of delayed infection occurred 33.3 ± 18.9 months postoperatively (3–62). The inflammatory indicators of Group A were significantly higher than those of Group B (all P < 0.05 ), except for procalcitonin. The main infection site in Group A was located on the skin and subcutaneous tissue and around the internal instrument, while the main infection site in Group B was around the internal instrument. The main treatment for Group A was debridement and implant replacement, and the main treatment for Group B was implant removal. Summary. The incidence of SSI following lumbar Dynesys dynamic internal fixation was 2.22%, the incidence of early SSI was 1.24%, and the incidence of delayed SSI was 0.98%. If the main infection site of early infection is in the incision, debridement should be the main treatment method; if the infection site is around the internal fixation, implant replacement is recommended on the basis of debridement. Once delayed infection is diagnosed, implant removal is suggested.

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“…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.…”

Section: Risk Factorsmentioning

confidence: 99%

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

Gupta

Badin

Leland

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Surgical site infection (SSI) is a major potential complication following pediatric spinal deformity surgery that is associated with significant morbidity and increased costs. Despite this, SSI rates remain high and variable across institutions, in part due to a lack of up-to-date, comprehensive prevention, and treatment protocols. Furthermore, few attempts have been made to review the optimal diagnostic modalities and treatment strategies for SSI following scoliosis surgery. The aim of this study was to systematically review current literature on risk factors for SSI in pediatric patients undergoing scoliosis surgery, as well as strategies for prevention, diagnosis, and treatment. Methods: On January 19, 2022, a systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting risk factors for acute, deep SSI (<90 d) or strategies for prevention, diagnosis, or treatment of SSI following pediatric scoliosis surgery were included. Each included article was assigned a level of evidence rating based on study design and quality. Extracted findings were organized into risk factors, preventive strategies, diagnostic modalities, and treatment options and each piece of evidence was graded based on quality, quantity, and consistency of underlying data. Results: A total of 77 studies met the inclusion criteria and were included in this systematic review, of which 2 were categorized as Level I, 3 as Level II, 64 as Level III, and 8 as Level IV. From these studies, a total of 29 pieces of evidence (grade C or higher) regarding SSI risk factors, prevention, diagnosis, or treatment were synthesized. Conclusions: We present an updated review of published evidence for defining high-risk patients and preventing, diagnosing, and treating SSI after pediatric scoliosis surgery. The collated evidence presented herein may help limit variability in practice and decrease the incidence of SSI in pediatric spine surgery. Level of Evidence: Level III—systematic review.

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Risk Factors for Early Infection in Pediatric Spinal Deformity Surgery: A Multivariate Analysis

Cited by 11 publications

References 24 publications

Incidence, Management and Outcome of Delayed Deep Surgical Site Infection Following Spinal Deformity Surgery: 20-Year Experience at a Single Institution

Incidence, Management and Outcome of Delayed Deep Surgical Site Infection Following Spinal Deformity Surgery: 20-Year Experience at a Single Institution

Postoperative Management Strategy of Surgical Site Infection following Lumbar Dynesys Dynamic Internal Fixation

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

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