Deep wound infection following pediatric scoliosis surgery: incidence and analysis of risk factors

Abstract

Background:Deep wound infection after spinal surgery is a severe complication that often requires prolonged medical and surgical management. It can compromise the outcome of the deformity correction, especially in patients requiring surgical intervention with subsequent removal of implants. Ascertaining the incidence and risk factors leading to infection may help to prevent this problem. Methods:We reviewed the hospital charts of all patients who underwent spinal deformity correction from 1996 to 2005. Results:In all, 227 patients were identified (139 idiopathic, 57 neuromuscular, 8 syndromic, 6 congenital, 17 other); 191 patients were treated with posterior instrumentation and fusion, 11 with anterior-only procedures and 24 with combined anterior and posterior procedures. Final follow-up ranged from 1 to 9.5 years. Infection developed in 14 patients. The overall incidence of infection was 6.2%. Drainage and back pain were the most common presenting symptoms. The incidence of infection was higher among patients with nonidiopathic diagnoses (risk ratio [RR] 8.65, p < 0.001). Use of allograft bone was associated with a higher rate of infection (RR 9.66, p < 0.001) even when stratified by diagnosis (nonidiopathic diagnoses, RR 7.6, p = 0.012). Higher volume of instrumentation was also a risk factor for infection (p = 0.022). Coagulasenegative Staphyloccocus was the most commonly identified organism, followed by Propionibacterium acnes and Pseudomonas. Conclusion:Development of infection following scoliosis surgery was found to be associated with several risk factors, including a nonidiopathic diagnosis, the use of allograft and a higher volume of instrumentation. Preventative measures addressing these factors may decrease the rate of infection.Contexte : L'infection profonde de la plaie après une intervention chirurgicale à la colonne est une complication grave qui nécessite souvent un traitement médical et chirurgical prolongé. L'infection peut compromettre le résultat de la correction d'une malformation, surtout chez les patients qui doivent subir une autre intervention chirurgicale pour retirer des implants. La détermination de l'incidence et des facteurs de risque d'infection pourrait aider à éviter le problème.Méthodes : Nous avons examiné les dossiers d'hôpital de tous les patients qui ont subi, de 1996 à 2005, une intervention chirurgicale à la colonne visant à corriger une malformation.

Origin of Propionibacterium in Surgical Wounds and Evidence-Based Approach for Culturing Propionibacterium from Surgical Sites

“…P ropionibacterium species are often grown on culture of specimens obtained at the time of orthopaedic revision surgery. The pathogenicity of this organism has been demonstrated for patients who have undergone shoulder implant surgery [1][2][3][4][5][6][7][8][9][10][11][12][13][14] , hip or knee arthroplasty [15][16][17][18][19][20][21][22] , or spine surgery [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] . While many cases of Propionibacterium infections are attributed to Propionibacterium acnes, other species of Propionibacterium have been recovered from revision surgical sites 38 .…”

Surgical site infection after pediatric spinal deformity surgery

“…Neuromuscular patients were more likely to have an ASA score greater than 2 [35]. Similarly, Aleissa et al found a significantly higher risk of infection in patients with non-idiopathic diagnoses who had undergone spinal fusion for scoliosis [11]. Sponseller et al demonstrated that degree of cognitive impairment was a significant risk factor for deep SSI after scoliosis surgery in patients with cerebral palsy and myelodysplasia.…”

“…None of the neuromuscular patients who received autograft bone alone developed an infection, whereas 18% of the neuromuscular patients who received allograft bone developed an infection. The authors postulated that host defenses may be overwhelmed by the presence of a large amount of devitalized bone in patients who are already relatively immunocompromised [11]. In contrast, Master et al did not find that use of allograft bone correlated with increased risk of deep SSI in the neuromuscular population [8].…”

“…Infection after PSF is most common, whereas infection after anterior spinal fusion is rare. In patients who have undergone combined anterior and posterior spinal fusion, infection typically occurs only in the posterior wound [7,11,15]. Both Sponseller et al and Aleissa et al found that use of allograft bone was a significant risk factor for SSI after scoliosis surgery, particularly in neuromuscular patients [11,21].…”

“…In patients who have undergone combined anterior and posterior spinal fusion, infection typically occurs only in the posterior wound [7,11,15]. Both Sponseller et al and Aleissa et al found that use of allograft bone was a significant risk factor for SSI after scoliosis surgery, particularly in neuromuscular patients [11,21]. In Sponseller et al's series of cerebral palsy and myelodysplasia patients, 68% of patients in the infected group received allograft bone, compared with only 16% of patients in the uninfected group [21].…”