Risk Factors for Surgical Site Infections After Pediatric Spine Operations

Croft, Lindsay; Pottinger, Jean M.; Chiang, Hsiu‐Yin; Ziebold, Christine S.; Weinstein, Stuart L.; Herwaldt, Loreen A.

doi:10.1097/brs.0000000000000693

Cited by 49 publications

(42 citation statements)

References 36 publications

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“…The presence of a tracheostomy and presurgical ventilator dependence (including the use of continuous and bilevel positive airway pressure) were identified as risk 8,21,28 Higher ASA classification is a common risk factor identified in the literature, with classes greater than II being associated with postoperative complications, 8,21 as reported in the current study. Several studies have examined the outcomes of pediatric patients with significant respiratory compromise who underwent spinal surgery.…”

Section: Discussionsupporting

confidence: 49%

Complications following lengthening of spinal growing implants: is postoperative admission necessary?

Shaw

Fletcher

Devito

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThe aim of this study was to evaluate the effect of postoperative admission status on 30-day perioperative complications in patients with growing spinal instrumentation undergoing surgical lengthening.METHODSThis retrospective case-control study of records from the 2014–2015 National Surgical Quality Improvement Program–Pediatric database was performed to identify surgical lengthening procedures of spinal implants in patients with growing instrumentation by Current Procedural Terminology code. The 30-day postoperative complications were classified according to the Clavien-Dindo system. Patients were subdivided according to their postsurgical admission status. Admission status, American Society of Anesthesiologists (ASA) Physical Status classification, tracheostomy, neuromuscular diagnosis, ventilator dependence, and nutritional support were considered as possible risk factors in univariate and multivariate logistic regression analyses.RESULTSA total of 796 patients were identified (mean age 9.09 ± 3.44 years; 54% of patients were female), of whom 73% underwent lengthening on an inpatient basis. Patients with a tracheostomy or ventilator dependence were more likely to be admitted postoperatively. The overall rate of major complications was 3.5% and did not differ based on admission status (2.8% inpatient vs 3.8% outpatient, p = 0.517). On univariate analysis, ventilator dependence (9.5% vs 2.7%, p = 0.002), need for nutritional support (7.1% vs 2.5%, p = 0.006), and ASA class > II (4.8% vs 1.3%, p = 0.04) placed patients at a higher risk for any postoperative complications. Multivariate analysis identified only ventilator dependence as an independent risk factor for any perioperative complication.CONCLUSIONSPostoperative admission status did not affect the rate of 30-day perioperative complications, readmission, or rate of unplanned operations following lengthening of growing spinal instrumentation. Outpatient lengthening appears to be safe; however, consideration for postoperative admission should be given for those who are ventilator dependent.

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Section: Discussionsupporting

confidence: 49%

Complications following lengthening of spinal growing implants: is postoperative admission necessary?

Shaw

Fletcher

Devito

et al. 2018

Journal of Neurosurgery: Pediatrics

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“…Childhood obesity has been previously associated with an increased risk of complications in adolescent idiopathic scoliosis, and is a growing concern in medicine. 19,39 Although obesity is potentially modifiable for elective procedures, it is very difficult to address in patients with neuromuscular disorders. 40 Strategies for pediatric weight loss that may be useful in a healthier pediatric population, such as weight management programs, medication, and bariatric surgery, may be unfeasible or dangerous in the NMS population.…”

Section: Discussionmentioning

confidence: 99%

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

Basques

Chung

Lukasiewicz

et al. 2015

SPINE

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“…Increased blood loss is recognized as a risk factor for development of a SSI in pediatric spine surgery. [26] Estimated blood loss is also clearly related to compliance status, as one component of the compliance bundle was re-dosing after blood transfusion. Levels fused and operative time cause blood loss which are likely to lead to non-compliance, and more specifically, failure to re-dose after transfusion.…”

Section: Discussionmentioning

confidence: 99%

Compliance With a Comprehensive Antibiotic Protocol Improves Infection Incidence in Pediatric Spine Surgery

Vandenberg¹,

Niswander

Carry

et al. 2018

Journal of Pediatric Orthopaedics

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Background A multidisciplinary task force, designated Target Zero (TZ), has developed protocols for prevention of surgical site infection (SSI) for spine surgery at our institution. The purpose of this study was to evaluate how compliance with an antibiotic bundle impacts infection incidences in pediatric spine surgery. Methods After institutional review board approval, a consecutive series of 511 patients (517 procedures) who underwent primary spine procedures from 2008-2012 were retrospectively reviewed to identify patients who developed SSI. Patients were followed for a minimum of 90 days postoperatively. Compliance data was collected prospectively in 511 consecutive patients and a total of 517 procedures. Three criteria were required for antibiotic bundle compliance: appropriate antibiotics completely administered within one hour prior to incision, antibiotics appropriately re-dosed intraoperatively for blood loss and time, and antibiotics discontinued within 24 hours postoperatively. A multivariable logistic regression analysis was used to test the association between compliance and the development of an infection. Results Overall antibiotic bundle compliance rate was 85%. After adjusting for risk category, estimated blood loss, and study year, the likelihood of an infection was increased in the non-compliant group compared to the compliant group [adjusted odds ratio: 3.0, 95% CI: 0.96 to 9.47, p = 0.0587]. When expressed as the Number Needed to Treat (NNT), strict adherence to antibiotic bundle compliance prevented one SSI within 90 days of surgery for every 26 patients treated with the antibiotic bundle. Reasons for non-compliance included failure to infuse preoperative antibiotics one hour prior to incision (10.3%), failure to re-dose antibiotics intraoperatively based on time or blood loss (5.5%), and failure to discontinue antibiotics within 24 hours postoperatively (1.9%). Conclusions Compliance with a comprehensive antibiotic protocol can lead to meaningful reductions in surgical site infection (SSI) incidences in pediatric spine surgery. Institutions should focus on improving compliance with prophylactic antibiotic protocols to decrease SSI in pediatric spine surgery. Level of Evidence Retrospective cohort study, Level III

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Risk Factors for Surgical Site Infections After Pediatric Spine Operations

Cited by 49 publications

References 36 publications

Complications following lengthening of spinal growing implants: is postoperative admission necessary?

Complications following lengthening of spinal growing implants: is postoperative admission necessary?

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

Compliance With a Comprehensive Antibiotic Protocol Improves Infection Incidence in Pediatric Spine Surgery

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