Surgical Site Infection Following Primary Definitive Fusion for Pediatric Spinal Deformity

Abstract

on behalf of the Japan Spinal Deformity Institute Study Group Study Design. A retrospective multicenter study. Objective. To determine the surgical site infection (SSI) rate, associated risk factors, and causative pathogens in pediatric patients with spinal deformity. Summary of Background Data.There have been no extensive investigations of the risk factors for SSI in Japan. Methods. Demographic data, radiographic findings, and the incidence of SSI were retrospectively analyzed in 1449 pediatric patients who underwent primary definitive fusion surgery for spinal deformity at any of 15 institutions from 2015 to 2017. SSI was defined according to the US Centers for Disease Control and Prevention guideline. Results. The incidence of all SSIs was 1.4% and that of deep SSIs was 0.76%. The most common pathogenic microbes were methicillin-resistant staphylococci (n ¼ 5) followed by gram-negative rods (n ¼ 4), methicillin-sensitive staphylococci (n ¼ 1), and others (n ¼ 10). In univariate analysis, younger age, male sex, a diagnosis of kyphosis, type of scoliosis, American Society of Anesthesiologists (ASA) class !3, mental retardation urinary incontinence, combined anterior-posterior fusion, greater magnitude of kyphosis, three-column osteotomy, use of blood transfusion, and number of antibiotic administration were associated with the likelihood of SSI (all P < 0.05). Multivariate logistic regression analysis identified the following independent risk factors for SSI: syndromic scoliosis etiology (vs. idiopathic scoliosis; adjusted odds ratio [OR] 16.106; 95% confidence interval [CI] 2. neuromuscular scoliosis etiology (vs. idiopathic scoliosis; adjusted OR 11.814; ASA class 3 (vs. class 2; adjusted OR 15.231;, and administration of antibiotic therapy twice daily (vs. three times daily; adjusted OR 6.121; 95% CI 1.261-29.718). Conclusion.The overall infection rate was low. The most common causative bacteria were methicillin-resistant followed by gram-negative rods. Independent risk factors for SSI in pediatric patients undergoing spinal deformity surgery were scoliosis etiology, ASA class 3, and administration of antibiotic therapy twice daily.

Allogeneic Red Blood Cell Transfusion and Infectious Complications Following Pediatric Spinal Fusion

“…This multicenter study examined the association between ARBT and postoperative infections in children treated with spinal fusion. The observed frequencies of transfusion and postoperative infection align with published findings in this patient population 34-36,52-54 . Our analysis was also consistent with prior studies in identifying several risk factors for postoperative infection, including age, sex, ASA status, neuromuscular spinal deformity, operative time, number of spinal levels fused, and ARBT 36,55 .…”

“…The rate of allogeneic blood transfusion ranges from 17.8% for idiopathic scoliosis to 57% for neuromuscular scoliosis 34 , 35 . Observational studies examining the association between ARBT and postoperative infections in this population have shown conflicting results 36 - 38 . Inconsistent findings may have resulted from methodologic limitations, such as small sample size and inadequate bias control 37 , 39 .…”

Best Practice Guidelines for Surgical Site Infection in High-risk Pediatric Spine Surgery: Definition, Prevention, Diagnosis, and Treatment

“…A modification to include patients who are incontinent or at an increased risk of SSI allowed this to reach consensus (Tables 3 and 4). Notably, data supporting the use of preoperative urine cultures is only present in myelomeningocele patients, to our knowledge 5. Preoperative nutritional assessment was also a BPG in 2013 but only reached consensus when using BMI percentile for age in the current BPG 24.…”

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

“…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.…”

“…One Level III study reported that American Society of Anesthesiologists (ASA) class 3 patients had greater odds of acute postoperative infection than ASA class 2 patients, 35 while 2 Level III studies reported that ASA class was not a significant predictor of SSI occurrence. 29,59 Conclusions: There is grade C conflicting evidence that ASA class is associated with SSI risk after scoliosis surgery in pediatric populations.…”