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Grush AE, Mohan VE, Roy MG, Burns HR, Monson LA. Plastic surgeon closure is comparable to orthopedic closure when a perioperative optimization protocol is instituted for pediatric patients with neuromuscular scoliosis. Spine J 2024; 24:454-461. [PMID: 37979696 DOI: 10.1016/j.spinee.2023.11.003] [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: 05/17/2023] [Revised: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND CONTEXT Since 2015, plastic multilayer closure (PMC) has been gaining attraction due to improved wound healing outcomes for medically complex patients. Plastic multilayer closure has been readily used for complex spine surgery closures in patients susceptible to wound healing issues (ie, dehiscence, surgical site infection [SSI]). However, PMC requires extensive soft tissue manipulation compared with standard orthopedic spine surgeon closure (SOC) and can result in extended operative times, increased transfusion rates, and more frequent returns to the operating room. PURPOSE From 2016 to 2019, our institution implemented a perioperative protocol designed to decrease postoperative complication rates in NMS patients. A retrospective cohort study was performed to determine if PMC imparted advantages over SOC above and beyond that from the perioperative protocol. STUDY DESIGN/SETTING Retrospective study at a single academic institution. PATIENT SAMPLE Eighty-one pediatric patients with neuromuscular scoliosis undergoing spinal fixation surgery. OUTCOME MEASURES Postoperative wound complications such as surgical site infection, hematoma, and superficial/deep dehiscence were the main outcome measures. Respiratory and neuromuscular complications along with duration of surgery were also recorded. METHODS A retrospective review was conducted of NMS patients undergoing spinal fixation at a single academic pediatric hospital over 4 years. Cases were labeled as SOC (n=41) or PMC (n=40) based on the closure technique applied. Reported 90-day complications were evaluated as the primary outcome. RESULTS Of the 81 reviewed patients, 45 reported complications, roughly equal between the study groups. While we found no statistically significant differences in rates of postoperative complications or SSIs, SOC cases were 30 minutes shorter on average with fewer returns to the operating room for additional surgery. CONCLUSIONS With the implementation of our perioperative protocol for NMS patients, PMC did not result in fewer complications than SOC but the surgeries did take longer.
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Affiliation(s)
- Andrew E Grush
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, 6701 Fannin St, Suite 610, TX, USA; Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, 6701 Fannin St, Suite 610, TX, USA
| | - Vamsi E Mohan
- Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, El Paso, TX 79905, USA
| | - Michelle G Roy
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, 6701 Fannin St, Suite 610, TX, USA; Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, 6701 Fannin St, Suite 610, TX, USA
| | - Heather R Burns
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, 6701 Fannin St, Suite 610, TX, USA; Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, 6701 Fannin St, Suite 610, TX, USA
| | - Laura A Monson
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, 6701 Fannin St, Suite 610, TX, USA; Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, 6701 Fannin St, Suite 610, TX, USA.
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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.
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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
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Bradko V, Castillo H, Conklin M, Fremion E, Rocque B, Hanson D, Sanz-Cortes M, Whitehead W, Castillo J. Team Approach: The Management of Adolescents and Adults with Scoliosis and Spina Bifida. JBJS Rev 2022; 10:01874474-202203000-00004. [PMID: 35230996 DOI: 10.2106/jbjs.rvw.21.00167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
» Globally, the prevalence of myelomeningocele, the most common subtype of spina bifida, is 0.2 to 6.5 per 1,000 live births. In the U.S., adults account for >67% of the overall population with spina bifida. » With an estimated prevalence of up to 50%, scoliosis is one of the most common and severe orthopaedic conditions in patients with myelomeningocele. » The variable effects that scoliosis can have on an individual, the comorbidities associated with progressive scoliosis, and the risks associated with spine surgery call for a strong partnership and care coordination between medical and surgical teams to deliver a patient-centered approach. » A coordinated, structured, planned, and incremental team approach can help individuals achieve the overall goals of functionality and independence, as well as successful transition to adulthood. » Teams should consider a patient's social determinants of health (e.g., poverty or language barriers) and the effect of scoliosis on quality of life before proceeding with spinal deformity correction.
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Affiliation(s)
- Viachaslau Bradko
- Meyer Center for Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Heidi Castillo
- Meyer Center for Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Michael Conklin
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ellen Fremion
- Departments of Internal Medicine and Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Brandon Rocque
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Darrell Hanson
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | | | - William Whitehead
- Department of Pediatric Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Jonathan Castillo
- Meyer Center for Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Bortz C, Dinizo M, Kummer N, Brown A, Alas H, Pierce KE, Janjua MB, Park P, Wang C, Jankowski P, Hockley A, Soroceanu A, De la Garza Ramos R, Sciubba DM, Frempong-Boadu A, Vasquez-Montes D, Diebo BG, Gerling MC, Passias PG. Same Day Surgical Intervention Dramatically Minimizes Complication Occurrence and Optimizes Perioperative Outcomes for Central Cord Syndrome. Clin Spine Surg 2021; 34:308-311. [PMID: 34292197 DOI: 10.1097/bsd.0000000000001234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The aim of this study was to investigate associations between time to surgical intervention and outcomes for central cord syndrome (CCS) patients. BACKGROUND As surgery is increasingly recommended for patients with neurological deterioration CCS, it is important to investigate the relationship between time to surgery and outcomes. MATERIALS AND METHODS CCS patients were isolated in Nationwide Inpatient Sample database 2005-2013. Patients were grouped by time to surgery: same-day, 1-day delay, 2, 3, 4-7, 8-14, and >14 days. Means comparison tests compared patient factors, perioperative complications, and charges across patient groups. Controlling for age, comorbidities, length of stay, and concurrent traumatic fractures, binary logistic regression assessed surgical timing associated with increased odds of perioperative complication, using same-day as reference group. RESULTS Included: 6734 CSS patients (64% underwent surgery). The most common injury mechanisms were falls (30%) and pedestrian accidents (7%). Of patients that underwent surgery, 52% underwent fusion, 30% discectomy, and 14% other decompression of the spinal canal. Breakdown by time to procedure was: 39% same-day, 16% 1-day, 10% 2 days, 8% 3 days, 16% 4-7 days, 8% 8-14 days, and 3% >14 days. Timing groups did not differ in trauma status at admission, although age varied: [minimum: 1 d (58±15 y), maximum: >14 d (63±13 y)]. Relative to other groups, same-day patients had the lowest hospital charges, highest rates of home discharge, and second lowest postoperative length of stay behind 2-day delay patients. Patients delayed >14 days to surgery had increased odds of perioperative cardiac and infection complications. Timing groups beyond 3 days showed increased odds of VTE and nonhome discharge. CONCLUSIONS CCS patients undergoing surgery on the same day as admission had lower odds of complication, hospital charges, and higher rates of home discharge than patients that experienced a delay to operation. Patients delayed >14 days to surgery were associated with inferior outcomes, including increased odds of cardiac complication and infection.
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Affiliation(s)
- Cole Bortz
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Michael Dinizo
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Nicholas Kummer
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Avery Brown
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Haddy Alas
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Katherine E Pierce
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Muhammad B Janjua
- Department of Pediatric Neurosurgery, UT Southwestern Medical Center, Dallas, TX
| | - Paul Park
- Department of Neurologic Surgery, University of Michigan, Ann Arbor, MI
| | - Charles Wang
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Pawel Jankowski
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Aaron Hockley
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Alex Soroceanu
- Department of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Rafael De la Garza Ramos
- Department of Neurological Surgery Montefiore Medical Center/Albert Einstein College of Medicine Bronx, NY
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Bassel G Diebo
- Deparment of Orthopedic Surgery, SUNY Downstate, New York, NY
| | - Michael C Gerling
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
| | - Peter G Passias
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY
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Clark KW, Luhmann SJ. Utility of preoperative labs in posterior spinal fusions for idiopathic scoliosis. Spine Deform 2021; 9:1379-1385. [PMID: 33844194 DOI: 10.1007/s43390-021-00341-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/27/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Review of 216 consecutive idiopathic scoliosis (IS) patients undergoing posterior spinal fusion (PSF) demonstrated 94.9% having abnormal lab values, but only 3.9% were referred for further evaluation. A limited set of preoperative laboratory testing costing $234/patient, and thorough, adjunct review of patient/family history could identify potentially significant comorbidities preoperatively in this study. A savings of $1556/patient from current laboratory testing was identified. METHODS The laboratory tests routinely obtained preoperatively were investigated: abnormal preoperative laboratory outcomes were identified and further documented if additional action was taken defined as a referral to another medical provider, performance of additional lab testing or counseling, or if there was alteration of the surgical plan. RESULTS Overall, 94.9% (n = 205) of patients had one or more abnormal pre-operative lab values. Further actions occurred in 11.7% (n = 24) of all abnormal lab values with 3.9% (n = 8) of these being referred to other healthcare providers. Sixteen abnormal lab values underwent further testing or treatment: 11 nicotine tests, two UCx, one UA, one PT/PTT, and one bovine gelatin RAST. Eight abnormal tests prompted referral to another provider: three CBC, three platelet function tests, one UCx, and one UA. Based on these data, standard preoperative Hgb/Hct, platelet function tests, and bovine RAST (If the surgical plan involves use of bovine gelatin products) appear to be adequate to identify potential significant comorbidities in IS patients undergoing PSF for only $234/patient, a cost savings of $1556/patient from current protocol. CONCLUSION Based on this study of 216 patients, a limited preoperative laboratory testing and thorough, adjunct review of patient/family history appears to be adequate to identify potential comorbidities preoperatively in this study. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Kevin W Clark
- Department of Orthopaedic Surgery, St Louis Children's Hospital, Washington University School of Medicine, 1 Children's Place, Suite 4S60, Saint Louis, MO, 63110, USA
| | - Scott J Luhmann
- Department of Orthopaedic Surgery, St Louis Children's Hospital, Washington University School of Medicine, 1 Children's Place, Suite 4S60, Saint Louis, MO, 63110, USA.
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Tipper GA, Chiwera L, Lucas J. Reducing Surgical Site Infection in Pediatric Scoliosis Surgery: A Multidisciplinary Improvement Program and Prospective 4-Year Audit. Global Spine J 2020; 10:633-639. [PMID: 32677570 PMCID: PMC7359689 DOI: 10.1177/2192568219868200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
STUDY DESIGN Single-center prospective cohort. OBJECTIVES To evaluate a multidisciplinary led, structured protocol for reducing surgical site infections (SSIs) in pediatric scoliosis surgery. METHODS Following a spike to 8.6% in local annual infection rate, a multidisciplinary team was convened to identify interventions. The team consisted of spinal surgeons, infectious diseases consultants, physiotherapists, specialist nurses, and theatre managers. A protocol was initiated, including preoperative skin decontamination; standardized operative site prepreparation; betadine-soaked swabs sutured to wound edges; blood loss minimization; 3 L0.9% saline pulsed-lavage; defined protocol of glove changes; antibiotic regime of preoperative gentamicin, intraoperative subfascial vancomycin powder, 48-hour cefuroxime; and intraoperative normothermia. A 4-year audit was initiated of all patients aged ≤18 years undergoing corrective spinal deformity surgery. Institutional board review was not required. RESULTS Between January 1, 2014 and January 1, 2018, 414 operations were performed on 355 patients: male:female = 1:2.2, mean age 13.7 years (range 2.5-17.9), 233 idiopathic (mean operated vertebral levels 12), 122 neuromuscular (mean operated vertebral levels 14), 66 growing rod procedures, 41 multistage procedures. The mean number of operated vertebral levels both overall and in infected cases was 13 (range 2-17). Nine SSIs occurred in 8 patients at 3 months (4 neuromuscular), resulting in an overall SSI per operation of 2.2%. CONCLUSION A multidisciplinary approach with standardized measures significantly reduced SSIs in the unit's pediatric scoliosis surgery.
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Affiliation(s)
- Geoffrey A. Tipper
- The National Hospital for Neurology and Neurosurgery, London, UK,Geoffrey A. Tipper, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
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Garg S, Khechoyan D, Kim EB, French B. Multilayered and Flap Closure Technique for Pediatric Spinal Deformity Surgery. J Am Acad Orthop Surg 2020; 28:e92-e99. [PMID: 31977607 DOI: 10.5435/jaaos-d-18-00601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Wound complications after pediatric spinal deformity surgery are a relatively common and challenging complication that results in emotional, physical, and monetary costs to the patients, families, and healthcare providers. The role of wound closure techniques for the prevention of wound complications is being increasingly explored. Interdisciplinary care by spinal surgeons and plastic surgeons has been recently found to decrease wound complication rates in patients with nonidiopathic scoliosis.
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Affiliation(s)
- Sumeet Garg
- From the Pediatric Orthopaedics and Spine Surgery (Dr. Garg), Children's Hospital Colorado, the Pediatric Plastic and Reconstructive Surgery (Dr. Khechoyan and Dr. French), Children's Hospital Colorado, and the Musculoskeletal Research Center (Kim), Children's Hospital Colorado, Aurora, CO
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Glotzbecker M, Troy M, Miller P, Berry J, Cohen L, Gryzwna A, McCann ME, Hresko MT, Goobie S, Emans J, Brustowitz R, Snyder B, Hedequist D. Implementing a Multidisciplinary Clinical Pathway Can Reduce the Deep Surgical Site Infection Rate After Posterior Spinal Fusion in High-Risk Patients. Spine Deform 2019; 7:33-39. [PMID: 30587318 DOI: 10.1016/j.jspd.2018.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/20/2018] [Accepted: 06/23/2018] [Indexed: 01/19/2023]
Abstract
DESIGN Retrospective comparative study. OBJECTIVE The purpose of this study is to measure SSI outcomes before and after implementation of our center's multidisciplinary clinical pathway protocol for high-risk spinal surgery. BACKGROUND Surgical site infections (SSIs) after spinal fusion harm patients and are associated with significant health care costs. Given the high rate of SSI in neuromuscular populations, there is a rationale to develop infection prevention strategies. METHODS An institutional clinical pathway was created in 2012 and based on nationally published Best Practice Guidelines as well as hospital practices with a goal of reducing the rate of deep SSI in high-risk patients. Patient and procedure characteristics were compared prior to (2008-2011) and after (2012-2016) implementation of the pathway. Logistic regression using penalized maximum likelihood was used to assess differences in rate of infection before and after implementation. RESULTS Cohorts of 132 and 115 high-risk patients were analyzed before and after pathway implementation. Rate of deep infections decreased from 8% to 1% of patients (p = .005). Preoperative antibiotics were dosed within 1 hour in 90% of the postpathway cohort. Redosing was successful in 94% of patients for first redose and 79% for second redose. Betadine irrigation was used in 76% of cases and vancomycin administered in 86%. Multivariable analysis determined that instances of compliant antibiotics dosing had 63% lower odds of infection compared with instances of noncompliance (p = .04). CONCLUSIONS Implementation of a multidisciplinary pathway aimed to reduce infection in patients at high risk for SSI after spinal fusion led to a significant reduction in deep SSI rate. It is impossible to attribute the drop in the deep SSI rate to any one factor. Our results demonstrate that adherence to a protocol using multiple strategies to reduce infection results in a lower SSI rate, lower care costs, and improved patient-related outcomes. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Michael Glotzbecker
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA.
| | - Michael Troy
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Patricia Miller
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Jay Berry
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Lara Cohen
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Alexandra Gryzwna
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Mary Ellen McCann
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - M Timothy Hresko
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Susan Goobie
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - John Emans
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Robert Brustowitz
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Brian Snyder
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Daniel Hedequist
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
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