Risk Factors for Early Infection in Pediatric Spinal Deformity Surgery: A Multivariate Analysis

• Published in: Spine deformity 2019-05, Vol.7 (3), p.410-416
• Main Authors: Du, Jerry Y., Poe-Kochert, Connie, Thompson, George H., Son-Hing, Jochen P., Hardesty, Christina K., Mistovich, R. Justin
• Format: Article
• Language: English
• Subjects: Adolescent; Anesthesiology; Anti-Bacterial Agents - therapeutic use; Case Series; Case-Control Studies; Child; Crystalloid; Female; Humans; Infection; Male; Medicine & Public Health; Multivariate Analysis; Orthopedics; Pediatric scoliosis; Retrospective Studies; Risk factor; Risk Factors; Scoliosis - surgery; Spinal Fusion - adverse effects; Surgical Wound Infection - drug therapy; Surgical Wound Infection - epidemiology
• ISSN: 2212-134X; 2212-1358
• DOI: 10.1016/j.jspd.2018.09.011

Retrospective case-control study. To identify risk factors for early deep surgical site infections (SSIs; within three months of index procedure) following pediatric spinal deformity surgery. Deep surgical site infections (SSIs) following pediatric spinal deformity surgery are a source of significant morbidity. We sought to identify independent risk factors for early infection following primary, definitive single-stage pediatric posterior spinal fusion and instrumentation (PSFI). A total of 616 consecutive patients (2001–2016) from an institutional prospectively maintained Pediatric Orthopaedic Spine database were identified that met inclusion criteria of definitive single-stage PSFI. Early deep SSI was defined as infection within three months of index procedure requiring surgical intervention. A multivariate analysis of demographics, comorbidities, and perioperative factors was performed and independent risk factors were identified. Eleven patients (1.6%) developed an early deep SSI. Independent risk factors for SSI identified were nonidiopathic (neuromuscular, syndromic, and congenital) etiologies of scoliosis (adjusted odds ratio [aOR]: 8.384, 95% confidence interval [CI]: 1.784-39.386, p = .007) and amount of intraoperative crystalloids (aOR: 1.547 per additional liter of fluid, 95% CI: 1.057-2.263, p = .025). Mean crystalloid administered in the SSI group was 3.3 ± 1.2 L versus 2.4 ± 1.0 L in the noninfected group (p = .019). On univariate analysis, there was no significant difference in weight of patients between cohorts (p = .869) or surgery time (p = .089). There was also no significant difference in infection rates from redosing of antibiotics intraoperatively after 3 hours of surgery (p = .231). Nonidiopathic scoliosis and amount of intraoperative crystalloids were independently associated with early postoperative SSI. Further investigation into intraoperative fluid management may identify modifiable risk factors for early postoperative SSI in primary pediatric spinal deformity posterior spinal fusion patients. Level III, case-control study.