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Characterizing antibiotic prophylaxis practices in pediatric deformity spinal surgery and impact on 30-day postoperative infection: an NSQIP pediatric database study

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Abstract

Purpose

The aim of this study was to characterize antibiotic prophylaxis practices in pediatric patients who have received posterior arthrodesis for spinal deformity and understand how these practices impact 30-day postoperative infection rates.

Methods

This was a retrospective cohort study using the National Surgical Quality Improvement Program Pediatric database for year 2021. Patients 18 years of age or younger who received posterior arthrodesis for scoliosis or kyphosis correction were included. The outcome of interest was 30-day postoperative infection. Fisher’s exact test and multivariable regression analysis were used to analyze the impact of intravenous antibiotic prophylaxis, intraoperative intravenous antibiotic redosing after 4 h, postoperative antibiotic prophylaxis, intraoperative topical antibiotics on 30-day postoperative infection, and various antibiotic prophylaxis regimens.

Results

A total of 6974 patients were included in this study. The 30-day infection rate was 2.9%. Presurgical intravenous antibiotic (11.5% vs. 2.7%, p = 0.005), postoperative antibiotic (5.7% vs. 2.4%, p < 0.01), and intraoperative topical antibiotic (4.0% vs. 2.7%, p = 0.019) were associated with significantly reduced infection rates. There was no significant difference in infection rates between patients that received cefazolin versus vancomycin versus clindamycin. The addition of Gram-negative coverage did not result in significant differences in infection rates. Multivariable regression analysis found postoperative intravenous antibiotics and intraoperative topical antibiotics to reduce infection rates.

Conclusions

We found the use of presurgical intravenous antibiotics, postoperative intravenous antibiotics, and intraoperative topical antibiotics to significantly reduce infection rates. Results from this study can be applied to future research on implementation of standardized infection prevention protocols.

Level of evidence

Level II.

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Data availability

The data used is available to all participating NSQIP Pediatric sites.

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Acknowledgements

None.

Funding

This project was not supported by any sources of internal or external funding.

Author information

Authors and Affiliations

  1. UCLA Health, Los Angeles, 1131 Wilshire Blvd Suite 100, Santa Monica, CA, 90401, USA

    Vivien Chan

  2. Spine Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    David L. Skaggs

  3. Shriners Children’s Southern California, Pasadena, CA, USA

    Robert H. Cho & Selina C. Poon

  4. University of Saskatchewan, Saskatoon, SK, Canada

    Geoffrey Shumilak

Authors
  1. Vivien Chan
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  2. David L. Skaggs
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  3. Robert H. Cho
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  4. Selina C. Poon
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  5. Geoffrey Shumilak
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Contributions

VC, DLS, RHC, SCP, and GS: 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; VC, DLS, RHC, SCP, and GS: drafted the work or revised it critically for important intellectual content; VC, DLS, RHC, SCP, and GS: approved the version to be published; VC, DLS, RHC, SCP, and GS: agreed 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 Vivien Chan.

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Conflict of interest

Dr. Cho reports a consulting relationship with DePuy Synthes, OrthoPediatrics, NuVasive, Prosidyan, Pacira Biosciences, and Ergobaby. The other authors collectively report no conflicts of interest related to this research project.

Ethics approval

This study analyzes retrospective data from an anonymized database. Ethics approval was not required for this study.

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Chan, V., Skaggs, D.L., Cho, R.H. et al. Characterizing antibiotic prophylaxis practices in pediatric deformity spinal surgery and impact on 30-day postoperative infection: an NSQIP pediatric database study. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00844-9

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  • DOI: https://doi.org/10.1007/s43390-024-00844-9

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