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

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Abstract

Study Design

Retrospective case-control study.

Objectives

To identify risk factors for early deep surgical site infections (SSIs; within three months of index procedure) following pediatric spinal deformity surgery.

Background

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).

Methods

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.

Results

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).

Conclusions

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 of Evidence

Level III, case-control study.

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Author information

Authors and Affiliations

  1. Division of Pediatric Orthopaedics, Rainbow Babies & Children’s Hospitals/University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., 44106, Cleveland, OH, USA

    Jerry Y. Du MD, Connie Poe-Kochert CNP, George H. Thompson MD, Jochen P. Son-Hing MD, Christina K. Hardesty MD & R. Justin Mistovich MD

Authors
  1. Jerry Y. Du MD
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  2. Connie Poe-Kochert CNP
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  3. George H. Thompson MD
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  4. Jochen P. Son-Hing MD
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  5. Christina K. Hardesty MD
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  6. R. Justin Mistovich MD
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Corresponding author

Correspondence to Jerry Y. Du MD.

Additional information

Author disclosures: JYD (none), CPK (none), GHT (personal fees from Wolters Kluwer; personal fees and other from OrthoPediatrics and Shriner’s Hospital for Children, other from Scoliosis Research Society and NuVasive; from SpineForm [nonpaid consultant], outside the submitted work), JPSH (other from OrthoPediatrics, outside the submitted work), CKH (personal fees from Medtronic, Inc., and OrthoPediatrics, outside the submitted work), RJM (other from Right Mechanics, Inc., and OrthoPediatrics, outside the submitted work).

IRB Approval: This study was approved by the Rainbow Babies & Children’s Hospitals/University Hospitals Cleveland Medical Center institutional review board.

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Du, J.Y., Poe-Kochert, C., Thompson, G.H. et al. Risk Factors for Early Infection in Pediatric Spinal Deformity Surgery: A Multivariate Analysis. Spine Deform 7, 410–416 (2019). https://doi.org/10.1016/j.jspd.2018.09.011

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  • DOI: https://doi.org/10.1016/j.jspd.2018.09.011

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