Surgical site infection after pediatric spinal deformity surgery

Abstract

The incidence of surgical site infection (SSI) after spinal deformity surgery for adolescent idiopathic scoliosis ranges from 0.5-6.7%. The risk of infection following spinal fusion in patients with neuromuscular scoliosis is greater, with reported rates of 6.1-15.2% for cerebral palsy and 8-41.7% for myelodysplasia. SSIs result in increased patient morbidity, multiple operations, prolonged hospital stays, and significant financial costs. Recent literature has focused on elucidating the most common organisms involved in SSIs, as well as identifying modifiable risk factors and prevention strategies that may decrease the rates of infection. These include malnutrition, positive urine cultures, antibiotic prophylaxis, surgical site antisepsis, antibioticloaded allograft, local application of antibiotics, and irrigation solutions. Acute and delayed SSIs are managed differently. Removal of instrumentation is required for effective treatment of delayed SSIs. This review article examines the current literature on the prevention and management of SSIs after pediatric spinal deformity surgery.

Anthropometric characteristics, high prevalence of undernutrition and weight loss: impact on outcomes in patients with adolescent idiopathic scoliosis after spinal fusion

“…The incidence of wound infection, reported as the most common complication for PSF procedures in patients with idiopathic scoliosis [25], ranges from 0.5 to 6.7 % [26]. A clinically important finding from this study was the significantly increased risk of superficial wound infection in patients who lost [10 % body weight during the hospital stay.…”

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

“…For example, surgical site infections are seen in 0.5%-6.7% of patients undergoing pediatric deformity surgery. 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.…”

Predicting Short-term Morbidity in Patients Undergoing Posterior Spinal Fusion for Neuromuscular Scoliosis

“…1,3,7,8 The current body of literature regarding the NMS patient population and short-term outcomes after surgery is limited. Previous studies for such outcomes in NMS patients after major corrective surgery have been limited by small sample size, 2-4,7,9-11 examined a single complication such as infection, [11][12][13][14] reviewed multiple surgical procedures, 15 and/or included patients with adolescent idiopathic scoliosis. 1,12,14,[16][17][18] However, delineation of such associations is critical because short-term outcomes such as length of stay (LOS), adverse events (AEs), and readmission are associated with both poorer patient prognoses and higher hospital costs.…”