Surgical site infection prevention protocol for pediatric spinal deformity surgery: does it make a difference?

Poe-Kochert, Connie; Shimberg, Jilan L; Thompson, George H.; Son-Hing, Jochen P.; Hardesty, Christina K.; Mistovich, R. Justin

doi:10.1007/s43390-020-00120-6

Cited by 12 publications

(9 citation statements)

References 25 publications

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“…Two Level III studies reported that adoption of strategies outlined in the 2013 Best Practice Guidelines by Vitale et al 11 led to significant decreases in the incidence of SSI 75,76 . Other Level III studies have reported promising results after implementation of institution-specific protocols which similarly combine multiple evidence-based prevention practices, although these protocols were variable 66,77–79 …”

Section: Resultsmentioning

confidence: 99%

“…75,76 Other Level III studies have reported promising results after implementation of institution-specific protocols which similarly combine multiple evidence-based prevention practices, although these protocols were variable. 66,[77][78][79] Conclusions: There is grade B evidence that bundled SSI prevention protocols are effective at lowering the incidence of SSI after scoliosis surgery in pediatric populations.…”

Section: Implementation Of Bundled Ssi Prevention Protocolsmentioning

confidence: 98%

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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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Section: Resultsmentioning

confidence: 99%

Section: Implementation Of Bundled Ssi Prevention Protocolsmentioning

confidence: 98%

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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“…At our institution, comprehensive pre-surgery showering and washing procedures have been initiated. Similar protocols and other screening procedures are being tested or adopted at other institutions to reduce the rate of MR SSI [ 29 , 30 , 31 ]. Although SSI rates overall are in decline, including at our institution ( Figure 2 ), SSIs still occur, making countermeasures, to be taken upon occurrence, as important as prevention.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Successful Treatment of Deep Incisional Surgical Site Infections following Instrumented Spinal Surgeries: Retrospective Review of 1832 Cases

et al. 2022

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Background: Surgical site infection (SSI) is a major complication in spinal instrumentation that is often difficult to treat. The purpose of this study was to identify and determine prognostic indicators for successful treatment of spine instrumentation SSI. Methods: Retrospectively, spine surgery cases were examined on SSI diagnosis. Post-instrumentation SSI patients were categorized as “Successful” if SSI subsided after single debridement. Patients in whom SSI did not subsided and/or required removal of instrumentation were classified as “Challenging”. We investigated the relation of treatment outcomes to patients and treatment factors. Results: A total of 1832 spinal instrumentation cases were recognized with 44 (2.40%) SSI cases. White blood cell count, C-reactive protein (CRP) levels, causative bacteria (i.e., S. Aureus or MRSA), trauma injury, and early-stage antimicrobial agent sensitivity correlated with treatment prognosis. Multivariate analysis highlighted CRP levels and applying early-stage sensitive antibiotics as potential impactful predictive factors for successful treatment. Conclusions: Our results demonstrated that early selection of sensitive antimicrobial agents is critical and emphasizes the potential for early-stage classification methods such as Gram staining. Additionally, S. Aureus and MRSA SSI formed significantly more challenging infections to treat, thus requiring consideration when deciding on instrumentation retention. These factors offer promising aspects for further large-scale studies.

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“…Other investigators at major pediatric institutions have shown that routine use of best practices for high-risk children undergoing surgery for scoliosis is associated with a decreased incidence of SSI0. [28][29][30] Interestingly, Deveza et al 31 found a reduction in 1-year mortality among complex pediatric patients undergoing scoliosis surgery after a multidisciplinary process was instituted. While not designed to determine effects upon the incidences of SSI and neurological deficits, consistent with the present report, no differences were found between the preintervention and postintervention groups.…”

Section: Discussionmentioning

confidence: 99%

“…25 Others have shown the implementation of a structured perioperative pathway and/or adherence to best practice guidelines reduced the incidence of SSI in high-risk pediatric spine patients. [26][27][28][29][30] Investigators also found 1-year postoperative mortality among such patients was decreased by implementing a multidisciplinary process. 31 To date, the potential benefit of routine preoperative consultations with pediatric subspecialists in preparation for surgery for high-risk pediatric spine patients has not been clarified.…”

mentioning

confidence: 99%

Does Routine Subspecialty Consultation Before High-Risk Pediatric Spine Surgery Decrease the Incidence of Complications?

Visser

Lehman

Armstrong

2022

Journal of Pediatric Orthopaedics

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Background: Children with neuromuscular disorders and syndromic scoliosis who require operative treatment for scoliosis are at increased risk for postoperative complications. Complications may include surgical site infection and pulmonary system problems including respiratory failure, gastrointestinal system disorders, and others. The purpose of our study was to determine the effect of a standardized perioperative pathway specifically designed for management of high-risk pediatric patients undergoing surgery for scoliosis. Methods: The High-Risk Protocol (HRP) at our institution is a multidisciplinary process with subspecialty consultations before scoliosis surgery. This was a retrospective chart and radiographic review at a single institution. Inclusion criteria were high-risk subjects, age 8 to 18 years old, who underwent surgery between January, 2009 and April, 2009 with a minimum 2-year follow-up. Diagnoses included neuromuscular scoliosis or Syndromic scoliosis.Results: Seventy one subjects were analyzed. The mean age was 13 ( ± 2 SD) years. Follow-up was 63 ( ± 24 SD) months. The study group consisted of 35 subjects who had fully completed the HRP and the control group consisted of 36 subjects who did not. Nine of the 35 (26%) subjects in the HRP had surgery delayed while interventions were performed. Compared with controls, the study group had larger preoperative and postoperative curve magnitudes: 90 versus 73 degrees (P = 0.002) and 35 versus 22 degrees (P = 0.001). Pulmonary disease was more common in the HRP, 60 versus 31% (P = 0.013). The overall incidence of complications in the study group was 29% (10 of 35 subjects) and for controls 28% (10 of 36). There were no differences between groups for types of complications or Clavien-Dindo grades.Three subjects in the study group and 1 in the controls developed surgical site infection. Eleven subjects required unplanned reoperations during the study period. Conclusions: The findings of our study suggest a structured pathway requiring routine evaluations by pediatric subspecialists may not reduce complications for all high-risk pediatric spine patients. Selective use of consultants may be more appropriate.

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Surgical site infection prevention protocol for pediatric spinal deformity surgery: does it make a difference?

Cited by 12 publications

References 25 publications

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

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

Predictive Factors for Successful Treatment of Deep Incisional Surgical Site Infections following Instrumented Spinal Surgeries: Retrospective Review of 1832 Cases

Does Routine Subspecialty Consultation Before High-Risk Pediatric Spine Surgery Decrease the Incidence of Complications?

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