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Evaluating compliance with the 2013 best practice guidelines for preventing surgical site infection in high-risk pediatric spine surgery

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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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Data availability

Raw data were generated at Columbia University Medical Center, Department of Orthopaedics. Derived data supporting the findings of this study are available from the corresponding author AC-G on request.

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Acknowledgements

The authors thank Regina Wood, MPH from PSSG and Michelle Marks, PT MA from the Harms study group for their help with the distribution of the survey. They thank also Drs. Carol Hasler, René Castelein, Sébastien Pesenta, Ilkka Helenius, Dror Ovadia, David Farrington, Muharrem Yazici, Moyo Kruyt, Jorge Mineiro, and Oliana Madeira for helping distribute our survey among the EPOS Spine study group.

Funding

This study was not conducted with financial support.

Author information

Authors and Affiliations

  1. 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

    Alondra Concepción-González, J. Manuel Sarmiento, Christina C. Rymond, Hannah Lin, Kevin Lu, Afrain Z. Boby, Benjamin D. Roye & Michael G. Vitale

  2. Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA

    J. Manuel Sarmiento, Chinenye Ezeh, Benjamin D. Roye & Michael G. Vitale

  3. David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA

    Rishi Sinha

  4. Department of Biostatistics, Columbia University, New York, NY, USA

    Prakash Gorroochurn

  5. Pediatric Orthopaedic Department, Robert Debré Hospital, APHP, Paris Cité University, Paris, France

    Brice Ilharreborde

  6. Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN, 55905, USA

    A. Noelle Larson

Authors
  1. Alondra Concepción-González
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  2. J. Manuel Sarmiento
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  7. Kevin Lu
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  13. Michael G. Vitale
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Consortia

European Pediatric Orthopaedic Society Spine Study Group

Pediatric Spine Study Group

Harms Study Group

Contributions

AC-G, JMS, CCR, CE, RS, HL, KL, AZB, PG, BDR, BI, ANL, MGV, European Pediatric Orthopaedic Society Spine Study Group, Pediatric Spine Study Group, and Harms Study Group made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; they drafted the work or revised it critically for important intellectual content; approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Alondra Concepción-González.

Ethics declarations

Ethical approval

This study was approved by the Columbia University Institutional Review Board (Protocol AAAU3145) and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

This study qualifies for a waiver of consent because it is a survey of surgeons and does not involve patient participation. There is no potential to adversely affect the rights or welfare of subjects since this is a survey to gather surgeon opinion, with no patient data being collected or intervention being tested.

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Concepción-González, A., Sarmiento, J.M., Rymond, C.C. et al. Evaluating compliance with the 2013 best practice guidelines for preventing surgical site infection in high-risk pediatric spine surgery. Spine Deform 12, 47–56 (2024). https://doi.org/10.1007/s43390-023-00755-1

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