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Chan V, Skaggs DL, Cho RH, Poon SC, Shumilak G. Characterizing antibiotic prophylaxis practices in pediatric deformity spinal surgery and impact on 30-day postoperative infection: an NSQIP pediatric database study. Spine Deform 2024; 12:979-987. [PMID: 38499968 DOI: 10.1007/s43390-024-00844-9] [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: 12/20/2023] [Accepted: 02/09/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE The aim of this study was to characterize antibiotic prophylaxis practices in pediatric patients who have received posterior arthrodesis for spinal deformity and understand how these practices impact 30-day postoperative infection rates. METHODS This was a retrospective cohort study using the National Surgical Quality Improvement Program Pediatric database for year 2021. Patients 18 years of age or younger who received posterior arthrodesis for scoliosis or kyphosis correction were included. The outcome of interest was 30-day postoperative infection. Fisher's exact test and multivariable regression analysis were used to analyze the impact of intravenous antibiotic prophylaxis, intraoperative intravenous antibiotic redosing after 4 h, postoperative antibiotic prophylaxis, intraoperative topical antibiotics on 30-day postoperative infection, and various antibiotic prophylaxis regimens. RESULTS A total of 6974 patients were included in this study. The 30-day infection rate was 2.9%. Presurgical intravenous antibiotic (11.5% vs. 2.7%, p = 0.005), postoperative antibiotic (5.7% vs. 2.4%, p < 0.01), and intraoperative topical antibiotic (4.0% vs. 2.7%, p = 0.019) were associated with significantly reduced infection rates. There was no significant difference in infection rates between patients that received cefazolin versus vancomycin versus clindamycin. The addition of Gram-negative coverage did not result in significant differences in infection rates. Multivariable regression analysis found postoperative intravenous antibiotics and intraoperative topical antibiotics to reduce infection rates. CONCLUSIONS We found the use of presurgical intravenous antibiotics, postoperative intravenous antibiotics, and intraoperative topical antibiotics to significantly reduce infection rates. Results from this study can be applied to future research on implementation of standardized infection prevention protocols. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Vivien Chan
- UCLA Health, Los Angeles, 1131 Wilshire Blvd Suite 100, Santa Monica, CA, 90401, USA.
| | - David L Skaggs
- Spine Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert H Cho
- Shriners Children's Southern California, Pasadena, CA, USA
| | - Selina C Poon
- Shriners Children's Southern California, Pasadena, CA, USA
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Wang M, Xu L, Yang B, Du C, Zhu Z, Wang B, Qiu Y, Sun X. Incidence, Management and Outcome of Delayed Deep Surgical Site Infection Following Spinal Deformity Surgery: 20-Year Experience at a Single Institution. Global Spine J 2022; 12:1141-1150. [PMID: 33375859 PMCID: PMC9210238 DOI: 10.1177/2192568220978225] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES To investigate the incidence, management and outcome of delayed deep surgical site infection (SSI) after the spinal deformity surgery. METHODS This study reviewed 5044 consecutive patients who underwent spinal deformity corrective surgery and had been followed over 2 years. Delayed deep SSI were defined as infection involving fascia and muscle and occurring >3 months after the initial procedure. An attempt to retain the implant were initially made for all patients. If the infection failed to be eradicated, the implant removal should be put off until solid fusion was confirmed, usually more than 2 years after the initial surgery. Radiographic data at latest follow-up were compared versus that before implant removal. RESULTS With an average follow-up of 5.3 years, 56 (1.1%) patients were diagnosed as delayed deep SSI. Seven (12.5%) patients successfully retained instrumentation and there were no signs of recurrence during follow-up (average 3.4 years). The remaining patients, because of persistent or recurrent infection, underwent implant removal 2 years or beyond after the primary surgery, and solid fusion was detected in any case. However, at a minimum 1-year follow-up (average 3.9 years), an average loss of 9° in the thoracic curve and 8° in the thoracolumbar/lumbar curves was still observed. CONCLUSIONS Delayed deep SSI was rare after spinal deformity surgery. To eradicate infection, complete removal of implant may be required in the majority of delayed SSI. Surgeons must be aware of high likelihood of deformity progression after implant removal, despite radiographic solid fusion.
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Affiliation(s)
- Muyi Wang
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Liang Xu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Bo Yang
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Changzhi Du
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Zezhang Zhu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Bin Wang
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Yong Qiu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Xu Sun
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
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Postoperative Management Strategy of Surgical Site Infection following Lumbar Dynesys Dynamic Internal Fixation. Pain Res Manag 2021; 2021:2262837. [PMID: 34659599 PMCID: PMC8516528 DOI: 10.1155/2021/2262837] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022]
Abstract
Aim To research the incidence of surgical site infection (SSI) following lumbar Dynesys dynamic internal fixation and its management strategy. Methods We retrospectively analyzed all cases of lumbar Dynesys dynamic internal fixation performed from January 2010 to December 2019, and the data from patients with SSI were collected. The observational indicators included the incidence of SSI, general information of the patients, surgical details, inflammatory indicators, pathogenic bacteria, and treatment. SSI was defined as both early infection and delayed infection, and the cases were divided into Groups A and B, respectively. The relevant indicators and treatment were compared between the two groups. Results A total of 1125 cases of lumbar Dynesys dynamic internal fixation were followed up. Twenty-five cases of SSI occurred, and the incidence of SSI was 2.22% (25/1125). There were 14 cases of early infection (1.24%) and 11 cases of delayed infection (0.98%). Fourteen cases of early infection occurred 12.3 ± 8.3 days postoperatively (3–30), and 11 cases of delayed infection occurred 33.3 ± 18.9 months postoperatively (3–62). The inflammatory indicators of Group A were significantly higher than those of Group B (all P < 0.05), except for procalcitonin. The main infection site in Group A was located on the skin and subcutaneous tissue and around the internal instrument, while the main infection site in Group B was around the internal instrument. The main treatment for Group A was debridement and implant replacement, and the main treatment for Group B was implant removal. Summary. The incidence of SSI following lumbar Dynesys dynamic internal fixation was 2.22%, the incidence of early SSI was 1.24%, and the incidence of delayed SSI was 0.98%. If the main infection site of early infection is in the incision, debridement should be the main treatment method; if the infection site is around the internal fixation, implant replacement is recommended on the basis of debridement. Once delayed infection is diagnosed, implant removal is suggested.
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Taniguchi Y, Ohara T, Suzuki S, Watanabe K, Suzuki T, Uno K, Yamaguchi T, Yanagida H, Nakayama K, Kotani T, Watanabe K, Hirano T, Yamamoto T, Kawamura I, Sugawara R, Takeshita K, Demura S, Oku N, Sato T, Fujiwara K, Akazawa T, Murakami H, Kakutani K, Matsubayashi Y, Kawakami N. Incidence and Risk Factors for Unplanned Return to the Operating Room Following Primary Definitive Fusion for Pediatric Spinal Deformity: A Multicenter Study with Minimum 2-year Follow-Up. Spine (Phila Pa 1976) 2021; 46:E498-E504. [PMID: 33186273 DOI: 10.1097/brs.0000000000003822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective multicenter cohort study. OBJECTIVE The aim of this study was to identify the incidence and risk factors for UPROR within minimum 2-year follow-up in primary definitive fusion for pediatric spinal deformity. SUMMARY OF BACKGROUND DATA Several previous reports have elucidated the incidence of complications after pediatric scoliosis surgery; however, there has been no study that described the incidence and risk factors for unplanned return to the operating room (UPROR) with long-term follow-up in surgery for pediatric scoliosis with every etiology. METHODS We retrospectively extracted data of patients aged <19 years, from 14 institutes in Japan, who underwent primary definitive fusion surgery for spinal deformity between January 1, 2015 and December 31, 2017. The primary outcomes were the incidence of UPROR within the minimum 2-year follow-up period for any reason. Univariate and multivariate logistical analyses were conducted to identify potential risk factors associated with UPROR. RESULTS We identified 1417 eligible patients (287 males and 1130 females) with a mean age of 13.9 years. UPROR for any reason within minimum 2-year follow-up was identified in 68 patients (4.8%). The most frequent cause for UPROR was implant failure found in 29 patients, followed by surgical site infection in 14 patients, junctional problems in 10 patients, and neurological complications in six patients. The multivariate logistic regression analysis revealed that a diagnosis of kyphosis (odds ratio [OR], 2.65; 95% confidence interval [CI] 1.16-6.04), etiology of congenital or structural type (OR 2.21; 95% CI 1.08-4.53), etiology of syndromic type (OR 2.67; 95% CI 1.27-5.64), and increased operation time of ≥300 minutes (OR 1.81; 95% CI 1.07-3.07) were the risk factors for the incidence of UPROR. CONCLUSION The present multicenter study identified for the first time the incidence and risk factors for UPROR with minimum 2-year follow-up after primary definitive fusion surgery for pediatric spinal deformity with every etiology.Level of Evidence: 3.
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Affiliation(s)
- Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Tetsuya Ohara
- Department of Orthopedics and Spine Surgery, Meijo Hospital , Nagoya, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Teppei Suzuki
- Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Kobe, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Koki Uno
- Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Kobe, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Toru Yamaguchi
- Department of Orthopaedic and Spine Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Haruhisa Yanagida
- Department of Orthopaedic and Spine Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Keita Nakayama
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Toshiaki Kotani
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Kei Watanabe
- Department of Orthopaedic Surgery, School of Medicine, Niigata University, Niigata, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Toru Hirano
- Department of Orthopaedic Surgery, School of Medicine, Niigata University, Niigata, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Takuya Yamamoto
- Department of Orthopaedic Surgery, Japanese Red Cross Kagoshima Hospital, Kagoshima, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Ichiro Kawamura
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Ryo Sugawara
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Norihiro Oku
- Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Tatsuya Sato
- Department of Orthopedic Surgery, School of Medicine, Juntendo University, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Kenta Fujiwara
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, School of Medicine, Iwate Medical University, Morioka, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Noriaki Kawakami
- Department of Orthopedics and Spine Surgery, Meijo Hospital , Nagoya, Japan
- Devision of Spine Surgery, Department of Orthopedic Surgery, Ichinomiya Nishi Hospital, Ichinomiya, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
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Poe-Kochert C, Shimberg JL, Thompson GH, Son-Hing JP, Hardesty CK, Mistovich RJ. Surgical site infection prevention protocol for pediatric spinal deformity surgery: does it make a difference? Spine Deform 2020; 8:931-938. [PMID: 32356280 DOI: 10.1007/s43390-020-00120-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/09/2020] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE Can a standardized, hospital-wide care bundle decrease surgical site infection (SSI) rate in pediatric spinal deformity surgery? SSI is a major concern in pediatric spinal deformity surgery. METHODS We performed a retrospective review of our primary scoliosis surgeries between 1999 and 2017. In 2008, we implemented a standardized infection reduction bundle. Interventions included preoperative nares screening for methicillin-resistant staphylococcus aureus or methicillin-sensitive Staphylococcus aureus 2 weeks preoperatively, and treatment with intranasal mupirocin when positive, a bath or shower the night before surgery, a preoperative chlorohexidine scrub, timing of standardized antibiotic administration, standardized intraoperative re-dosing of antibiotics, limiting operating room traffic, and standardized postoperative wound care. In 2011, we added intrawound vancomycin powder at wound closure. Our inclusion criteria were patients 21 years of age or less with idiopathic, neuromuscular, syndromic, or congenital scoliosis who had a primary spinal fusion or a same day anterior and posterior spine fusion with segmental spinal instrumentation of six levels or more. We compared the incidence of early (within 90 days of surgery) and late (> 91 days) SSI during the first postoperative year. RESULTS There were 804 patients who met inclusion criteria: 404 in the non-bundle group (NBG) for cases prior to protocol change and 400 in the bundle group (BG) for cases after the protocol change. Postoperatively, there were 29 infections (7.2% of total cases) in the NBG: 9 early (2.2%) and 20 late (5.0%) while in the BG there were only 10 infection (2.5%): 6 early (1.5%) and 4 late (1.0%). The reduction in overall SSIs was statistically significant (p = 0.01). There was a trend toward decreased early infections in the BG, without reaching statistical significance (p = 0.14). CONCLUSION Standardized care bundles appear effective in reducing the incidence of postoperative pediatric spine SSIs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Connie Poe-Kochert
- Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, USA.,Case Western Reserve University School of Medicine, Cleveland, USA
| | - Jilan L Shimberg
- Case Western Reserve University School of Medicine, Cleveland, USA
| | - George H Thompson
- Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, USA.,Case Western Reserve University School of Medicine, Cleveland, USA
| | - Jochen P Son-Hing
- Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, USA.,Case Western Reserve University School of Medicine, Cleveland, USA
| | - Christina K Hardesty
- Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, USA.,Case Western Reserve University School of Medicine, Cleveland, USA
| | - R Justin Mistovich
- Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, USA. .,Case Western Reserve University School of Medicine, Cleveland, USA.
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Abstract
BACKGROUND Seromas are known complications after pediatric spinal deformity surgery. Although many surgeons perform an early debridement to prevent deep surgical site infections (SSIs), a less invasive approach to seroma management has not been studied. We hypothesized that a conservative approach to seroma management would be safe and yield equivalent outcomes. METHODS We performed a retrospective review of patients who developed a postoperative seroma with or without nonpurulent drainage. Inclusion criteria were patients below 21 years who underwent primary posterior spinal fusion from 1996 to 2016 and developed a postoperative wound seroma. Seromas were clinically defined as an afebrile patient with a fluid collection that was soft and nontender to palpation and without induration or erythema. Growing spine surgeries and revision procedures were excluded from this study. RESULTS Twenty-five of 790 total patients with a mean follow-up of 57.8 months (±48.5 mo) developed a seroma. Seromas were identified at a mean of 13.6 days postoperatively and resolved after a mean of 12.2 days following the presentation. Seromas occurred in 12 patients with idiopathic scoliosis, 12 with neuromuscular scoliosis, and 1 patient with Scheuermann kyphosis. All cases were managed conservatively with monitoring of the incision without an operative procedure. In cases of spontaneous drainage, a sterile dressing was applied to the wound and changed as needed until drainage ceased. Two patients underwent bedside needle aspiration and 5 patients received prophylactic antibiotics at the treating surgeon's discretion. All cases resolved spontaneously without development of an acute SSI. Three cases subsequently developed a late SSI (range, 18 to 38 mo postoperatively). Two had idiopathic scoliosis and 1 had neuromuscular scoliosis. None of these seromas drained spontaneously. CONCLUSIONS Conservative management of postoperative seromas after pediatric spinal deformity surgery is appropriate. It is unclear if seromas contributed to the development of the 3 late infections. Further studies are needed regarding the relationship of late infections in seroma patients. LEVEL OF EVIDENCE Level IV-case series.
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Vanderhave K, Cho RH, Liu R. What's New in Pediatric Orthopaedic Surgery. J Bone Joint Surg Am 2020; 102:275-282. [PMID: 31804237 DOI: 10.2106/jbjs.19.01143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Robert H Cho
- Shriners for Children Medical Center, Los Angeles, California
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