Skip to main content

Advertisement

Log in

Risk factors for surgical site infection following pediatric spinal deformity surgery: a systematic review and meta-analysis

  • Review Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

This study was conducted to identify risk factors for postoperative infection after pediatric spinal deformity surgery.

Methods

A systematic electronic literature search from inception to November 2014 was performed in the following databases: Pubmed, Embase, and Cochrane library databases. Pooled odds ratios (ORs) or standardized mean differences (SMDs) with 95 % confidence intervals (CIs) were calculated using random or fixed effects model. Newcastle-Ottawa scale was used to evaluate the methodological quality, and Stata 11.0 was used to analyze data.

Results

The main factors associated with infection after spinal surgery were idiopathic scoliosis (OR, 0.303; 95 % CI, 0.202–0.453), neuromuscular scoliosis (OR, 2.269; 95 % CI, 1.576–3.267), ambulatory status (OR, 0.241; 95 % CI, 0.078–0.747), previous spinal surgery (OR, 4.564; 95 % CI, 1.892–11.009), sacral vertebrae fused (OR, 2.717; 95 % CI, 1.836–4.020), and allograft (OR, 8.498; 95 % CI, 4.030–17.917). There was no sufficient evidence to reveal that male gender, age, body mass index, preoperative curve, preoperative urinary tract infection, combined anterior-posterior approach, estimated blood loss, and operating room time could lead to infection after spinal surgery.

Conclusions

We identified some risk factors which could be used to prevent the onset of surgical site infection in pediatric spinal deformity surgery. However, the results of this meta-analysis should be interpreted with caution because of the heterogeneity among the studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bachy M, Bouyer B, Vialle R (2012) Infections after spinal correction and fusion for spinal deformities in childhood and adolescence. Int Orthop 36(2):465–469. doi:10.1007/s00264-011-1439-8

    Article  PubMed Central  PubMed  Google Scholar 

  2. Cahill PJ, Warnick DE, Lee MJ, Gaughan J, Vogel LE, Hammerberg KW, Sturm PF (2010) Infection after spinal fusion for pediatric spinal deformity: thirty years of experience at a single institution. Spine 35(12):1211–1217. doi:10.1097/BRS.0b013e3181c212d1

    PubMed  Google Scholar 

  3. Farley FA, Li Y, Gilsdorf JR, VanderHave KL, Hensinger RN, Speers M, Childers D, Caird MS (2014) Postoperative spine and VEPTR infections in children: a case–control study. J Pediatr Orthop 34(1):14–21. doi:10.1097/BPO.0b013e3182a0064d

    Article  PubMed  Google Scholar 

  4. Kabirian N, Akbarnia BA, Pawelek JB, Alam M, Mundis GM Jr, Acacio R, Thompson GH, Marks DS, Gardner A, Sponseller PD, Skaggs DL (2014) Deep Surgical Site Infection Following 2344 Growing-Rod Procedures for Early-Onset Scoliosis: Risk Factors and Clinical Consequences. J Bone Joint Surg Am 96(15):e128. doi:10.2106/jbjs.m.00618

    Article  PubMed  Google Scholar 

  5. Sponseller PD, Shah SA, Abel MF, Newton PO, Letko L, Marks M (2010) Infection rate after spine surgery in cerebral palsy is high and impairs results: multicenter analysis of risk factors and treatment. Clin Orthop Relat Res 468(3):711–716. doi:10.1007/s11999-009-0933-4

    Article  PubMed Central  PubMed  Google Scholar 

  6. Sponseller PD, Jain A, Shah SA, Samdani A, Yaszay B, Newton PO, Thaxton LM, Bastrom TP, Marks MC (2013) Deep wound infections after spinal fusion in children with cerebral palsy: a prospective cohort study. Spine 38(23):2023–2027. doi:10.1097/BRS.0b013e3182a83e59

    Article  PubMed  Google Scholar 

  7. Mohamed Ali MH, Koutharawu DN, Miller F, Dabney K, Gabos P, Shah S, Holmes L Jr (2010) Operative and clinical markers of deep wound infection after spine fusion in children with cerebral palsy. J Pediatr Orthop 30(8):851–857. doi:10.1097/BPO.0b013e3181f59f3f

    Article  PubMed  Google Scholar 

  8. Perry JW, Montgomerie JZ, Swank S, Gilmore DS, Maeder K (1997) Wound infections following spinal fusion with posterior segmental spinal instrumentation. Clin Infect Dis 24(4):558–561

    Article  CAS  PubMed  Google Scholar 

  9. Sponseller PD, LaPorte DM, Hungerford MW, Eck K, Bridwell KH, Lenke LG (2000) Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes. Spine 25(19):2461–2466

    Article  CAS  PubMed  Google Scholar 

  10. Aleissa S, Parsons D, Grant J, Harder J, Howard J (2011) Deep wound infection following pediatric scoliosis surgery: incidence and analysis of risk factors. Can J Surg 54(4):263–269. doi:10.1503/cjs.008210

    Article  PubMed Central  PubMed  Google Scholar 

  11. Mikhael MM, Huddleston PM, Nassr A (2009) Postoperative culture positive surgical site infections after the use of irradiated allograft, nonirradiated allograft, or autograft for spinal fusion. Spine 34(22):2466–2468. doi:10.1097/BRS.0b013e3181b1fef5

    Article  PubMed  Google Scholar 

  12. Glotzbecker MP, Riedel MD, Vitale MG, Matsumoto H, Roye DP, Erickson M, Flynn JM, Saiman L (2013) What's the evidence? Systematic literature review of risk factors and preventive strategies for surgical site infection following pediatric spine surgery. J Pediatr Orthop 33(5):479–487. doi:10.1097/BPO.0b013e318285c507

    Article  PubMed  Google Scholar 

  13. Li Y, Glotzbecker M, Hedequist D (2012) Surgical site infection after pediatric spinal deformity surgery. Curr Rev Musculoskelet Med. doi:10.1007/s12178-012-9111-5

    PubMed Central  PubMed  Google Scholar 

  14. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605. doi:10.1007/s10654-010-9491-z

    Article  PubMed  Google Scholar 

  15. Lau J, Ioannidis JP, Terrin N, Schmid CH, Olkin I (2006) The case of the misleading funnel plot. BMJ (Clin Res) 333(7568):597–600. doi:10.1136/bmj.333.7568.597

    Article  Google Scholar 

  16. Wimmer C, Gluch H, Franzreb M, Ogon M (1998) Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 11(2):124–128

    CAS  PubMed  Google Scholar 

  17. Di Silvestre M, Bakaloudis G, Lolli F, Giacomini S (2011) Late-developing infection following posterior fusion for adolescent idiopathic scoliosis. Eur Spine J 20(Suppl 1):S121–S127. doi:10.1007/s00586-011-1754-1

    Article  PubMed  Google Scholar 

  18. Ho C, Sucato DJ, Richards BS (2007) Risk factors for the development of delayed infections following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis patients. Spine 32(20):2272–2277. doi:10.1097/BRS.0b013e31814b1c0b

    Article  PubMed  Google Scholar 

  19. Geiger F, Parsch D, Carstens C (1999) Complications of scoliosis surgery in children with myelomeningocele. Eur Spine J 8(1):22–26

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Hell AK, Campbell RM, Hefti F (2005) The vertical expandable prosthetic titanium rib implant for the treatment of thoracic insufficiency syndrome associated with congenital and neuromuscular scoliosis in young children. J Pediatr Orthop B 14(4):287–293

    Article  PubMed  Google Scholar 

  21. Labbe AC, Demers AM, Rodrigues R, Arlet V, Tanguay K, Moore DL (2003) Surgical-site infection following spinal fusion: a case–control study in a children's hospital. Infect Control Hosp Epidemiol 24(8):591–595. doi:10.1086/502259

    Article  PubMed  Google Scholar 

  22. Milstone AM, Maragakis LL, Townsend T, Speck K, Sponseller P, Song X, Perl TM (2008) Timing of preoperative antibiotic prophylaxis: a modifiable risk factor for deep surgical site infections after pediatric spinal fusion. Pediatr Infect Dis J 27(8):704–708. doi:10.1097/INF.0b013e31816fca72

    Article  PubMed  Google Scholar 

  23. Linam WM, Margolis PA, Staat MA, Britto MT, Hornung R, Cassedy A, Connelly BL (2009) Risk factors associated with surgical site infection after pediatric posterior spinal fusion procedure. Infect Control Hosp Epidemiol 30(2):109–116. doi:10.1086/593952

    Article  PubMed  Google Scholar 

  24. Master DL, Poe-Kochert C, Son-Hing J, Armstrong DG, Thompson GH (2011) Wound infections after surgery for neuromuscular scoliosis: risk factors and treatment outcomes. Spine 36(3):E179–E185. doi:10.1097/BRS.0b013e3181db7afe

    Article  PubMed  Google Scholar 

  25. Mackenzie WG, Matsumoto H, Williams BA, Corona J, Lee C, Cody SR, Covington L, Saiman L, Flynn JM, Skaggs DL, Roye DP Jr, Vitale MG (2013) Surgical site infection following spinal instrumentation for scoliosis: a multicenter analysis of rates, risk factors, and pathogens. J Bone Joint Surg Am 95(9):800–806. doi:10.2106/jbjs.l.00010, S801-802

    Article  PubMed  Google Scholar 

  26. Rihn JA, Lee JY, Ward WT (2008) Infection after the surgical treatment of adolescent idiopathic scoliosis: evaluation of the diagnosis, treatment, and impact on clinical outcomes. Spine 33(3):289–294. doi:10.1097/BRS.0b013e318162016e

    Article  PubMed  Google Scholar 

  27. Jevsevar DS, Karlin LI (1993) The relationship between preoperative nutritional status and complications after an operation for scoliosis in patients who have cerebral palsy. J Bone Joint Surg Am 75(6):880–884

    CAS  PubMed  Google Scholar 

  28. Schimmel JJ, Horsting PP, de Kleuver M, Wonders G, van Limbeek J (2010) Risk factors for deep surgical site infections after spinal fusion. Eur Spine J 19(10):1711–1719. doi:10.1007/s00586-010-1421-y

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Xianzhong Meng.

Additional information

Fei Meng and Junming Cao contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Meng, F., Cao, J. & Meng, X. Risk factors for surgical site infection following pediatric spinal deformity surgery: a systematic review and meta-analysis. Childs Nerv Syst 31, 521–527 (2015). https://doi.org/10.1007/s00381-015-2659-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-015-2659-9

Keywords

Navigation