Contributory Factors to Postoperative Spinal Fusion Complications for Children With Myelomeningocele

Hatlen, Timothy; Song, Kit M.; Shurtleff, David B.; Duguay, Sharon

doi:10.1097/brs.0b013e3181bf8efe

Cited by 61 publications

(47 citation statements)

References 27 publications

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“…25,28 As both presented individual patient characteristics with related outcome data, these participants were excluded from univariate statistical analysis. Three papers excluded neonates: Rojratsirikul et al excluded infants aged less than two months, 27 whilst Secker and Jeejeebhoy and Stey et al excluded neonates aged <31 days and <28 days, respectively.…”

Section: Search Resultsmentioning

confidence: 99%

“…23 Four studies were undertaken in cardiac surgical populations, 13,20,21,29 and four studies were undertaken in general surgical populations, mainly gastrointestinal/abdominal surgery. 16,17,26,27 Two studies were performed in spinal surgical populations, 25,29 and one study comprised of cardiac, neurosurgical and general surgical participants. 24 Stey et al reported on all children undergoing any type of surgery with data entered on to the American College of Surgeons National Surgical Quality Improvement Program Pediatric Report Form.…”

Section: Search Resultsmentioning

confidence: 99%

“…16,21,24,25,28,29 Definitions used for the identification of this outcome were consistent across the three studies 21,24,28 that used the criteria of the Centers for Disease Control and Prevention. 4 Bhattacharyya and Kosloske 16 used an ASEPSIS score >21, whilst Nateghian et al 29 used the National Nosocomial Infections Surveillance criteria, both of which are recognized criteria.…”

Section: Relationship Between Undernutrition and Infectionmentioning

confidence: 93%

“…13,26 One study used laboratory measures (serum albumin and haematocrit) alone to classify nutritional status. 25 Two studies compared a nutrition history questionnaire, the Subjective Global Assessment, against anthropometric assessments to assess the efficacy of the tool in identifying children at risk of postoperative complications. 12,27 The focus of these studies was to identify and compare undernourished children with their well-nourished counterparts; outcome data were extracted for both groups.…”

Section: Methods Of Nutritional Assessmentmentioning

confidence: 99%

“…23,24 Where participant numbers were low for the given study period, studies were downgraded to unclear risk of bias. 13,25,26 Unclear or non-validated infection definitions, 25 or unclear or less than accepted durations of follow-up made it difficult to assess exposure and/or case selection; these studies were downgraded accordingly. 13,16,17,20,21,24,26 Any study that adjusted for age and/or case complexity met the criteria for comparability.…”

Section: Quality Assessment Of Included Studiesmentioning

confidence: 99%

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Is undernutrition prognostic of infection complications in children undergoing surgery? A systematic review

Hill

Paulus

Dey

et al. 2016

Journal of Hospital Infection

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Background: Healthcare-associated infections are costly and are increasingly viewed as an indicator of the quality of care. Although strategies to reduce infections have become widespread, few studies have formally investigated the role of undernutrition on the development of infection-related complications in children after surgery. Aim: To perform a systematic review of the literature to determine if undernutrition is prognostic of postoperative infection complications in children. Methods: Electronic bibliographic and research databases were searched from 1950 to 2014. Inclusion criteria were studies in children (age <18 years) evaluating pre-operative nutritional status and reporting postoperative infection complications. Quality assessment was performed independently by two reviewers, with disagreements resolved by a third reviewer. The quality of the evidence was judged to be low in the majority of studies. Findings: Ten cohort and two caseecontrol studies met the inclusion criteria. Five studies reported an outcome combining infection-related complications, with the remainder reporting individual infection complications. Six studies reported surgical site infection (SSI) alone or in combination with other infection complications. Direct comparison between studies was difficult due to clinical and diagnostic heterogeneity. Unadjusted analyses (for patient or clinical variables) were suggestive of a relationship between undernutrition and infection complications. In studies controlling for other variables, the analyses did not remain significant for SSI. Conclusion: There was low-quality evidence that undernutrition may be predictive of postoperative infection complications in children, with the exception of SSI. However, inconsistencies in nutritional and outcome assessments made it difficult to draw conclusions. Larger, high-quality studies are warranted to further investigate a potential prognostic relationship. ª

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Section: Search Resultsmentioning

confidence: 99%