1
|
Concepción-González A, Sarmiento JM, Rymond CC, Ezeh C, Sinha R, Lin H, Lu K, Boby AZ, Gorroochurn P, Roye BD, Ilharreborde B, Larson AN, Vitale MG. Evaluating compliance with the 2013 best practice guidelines for preventing surgical site infection in high-risk pediatric spine surgery. Spine Deform 2024; 12:47-56. [PMID: 37665549 DOI: 10.1007/s43390-023-00755-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/29/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Best Practice Guidelines (BPGs) were published one decade ago to decrease surgical site infection (SSI) in pediatric spinal deformity. Successful implementation has not been established. This study evaluated surgeon compliance with items on the BPG. We hypothesized that BPG authors and surgeons with more experience, higher caseload, and awareness of the BPG would have higher compliance. METHODS We queried North American and European surgeons, authors and non-authors, and members of various spine study groups on adherence to BPGs using an anonymous survey. Mean compliance scores (MCSs) were developed by correlating Likert responses with MCSs ("None of the time" = no compliance = MCS 0, "Sometimes" = weak to moderate = MCS 1, "Most of the time" = high = MCS 2, "All the time" = perfect = MCS 3). RESULTS Of the 142 respondents, 73.7% reported high or perfect compliance. Average compliance scores for all guidelines was 2.2 ± 0.4. There were significantly different compliance scores between North American and European surgeons (2.3 vs 1.8, p < 0.001), authors and non-authors (2.5 vs. 2.2, p = 0.023), and surgeons with and without knowledge of the BPGs (2.3 vs. 1.8, p < 0.001). There was a weak correlation between BPG awareness and compliance (r = 0.34, p < 0.001) and no correlation between years in practice (r = 0.0, p = 0.37) or yearly caseload (r = 0.2, p = 0.78) with compliance. CONCLUSIONS Compliance among our cohort of surgeons surveyed was high. North American surgeons, authors of the BPGs and those aware of the guidelines had increased compliance. Participation in a spine study group, years in practice, and yearly caseload were not associated with compliance. LEVEL OF EVIDENCE Level V-expert opinion.
Collapse
Affiliation(s)
- Alondra Concepción-González
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, Morgan Stanley Children's Hospital of New York Presbyterian, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA.
| | - J Manuel Sarmiento
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, Morgan Stanley Children's Hospital of New York Presbyterian, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Christina C Rymond
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, Morgan Stanley Children's Hospital of New York Presbyterian, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Chinenye Ezeh
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Rishi Sinha
- David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Hannah Lin
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, Morgan Stanley Children's Hospital of New York Presbyterian, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Kevin Lu
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, Morgan Stanley Children's Hospital of New York Presbyterian, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Afrain Z Boby
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, Morgan Stanley Children's Hospital of New York Presbyterian, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
| | | | - Benjamin D Roye
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, Morgan Stanley Children's Hospital of New York Presbyterian, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Brice Ilharreborde
- Pediatric Orthopaedic Department, Robert Debré Hospital, APHP, Paris Cité University, Paris, France
| | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Michael G Vitale
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, Morgan Stanley Children's Hospital of New York Presbyterian, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
| |
Collapse
|
2
|
Best Practice Guidelines for Surgical Site Infection in High-risk Pediatric Spine Surgery: Definition, Prevention, Diagnosis, and Treatment. J Pediatr Orthop 2022; 42:e1008-e1017. [PMID: 36037438 DOI: 10.1097/bpo.0000000000002255] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prior "best practice guidelines" (BPG) have identified strategies to reduce the risk of acute deep surgical site infection (SSI), but there still exists large variability in practice. Further, there is still no consensus on which patients are "high risk" for SSI and how SSI should be diagnosed or treated in pediatric spine surgery. We sought to develop an updated, consensus-based BPG informed by available literature and expert opinion on defining high-SSI risk in pediatric spine surgery and on prevention, diagnosis, and treatment of SSI in this high-risk population. MATERIALS AND METHODS After a systematic review of the literature, an expert panel of 21 pediatric spine surgeons was selected from the Harms Study Group based on extensive experience in the field of pediatric spine surgery. Using the Delphi process and iterative survey rounds, the expert panel was surveyed for current practices, presented with the systematic review, given the opportunity to voice opinions through a live discussion session and asked to vote regarding preferences privately. Two survey rounds were conducted electronically, after which a live conference was held to present and discuss results. A final electronic survey was then conducted for final voting. Agreement ≥70% was considered consensus. Items near consensus were revised if feasible to achieve consensus in subsequent surveys. RESULTS Consensus was reached for 17 items for defining high-SSI risk, 17 items for preventing, 6 for diagnosing, and 9 for treating SSI in this high-risk population. After final voting, all 21 experts agreed to the publication and implementation of these items in their practice. CONCLUSIONS We present a set of updated consensus-based BPGs for defining high-risk and preventing, diagnosing, and treating SSI in high-risk pediatric spine surgery. We believe that this BPG can limit variability in practice and decrease the incidence of SSI in pediatric spine surgery. LEVEL OF EVIDENCE Not applicable.
Collapse
|