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Variability of Surgical Site Infection With VEPTR at Eight Centers: A Retrospective Cohort Analysis

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Abstract

Study Design

Retrospective review.

Objectives

To describe clinical characteristics and infection rates in modern vertical expandable prosthetic titanium rib (VEPTR) surgery. Summary of Background Data: Prior studies have demonstrated infection rates from 10% to 30% with VEPTR surgery.

Methods

A retrospective query was done on an institutional review boardeapproved, multicenter prospectively collected database for patients implanted with VEPTR from 2007 to 2013 at eight sites. This identified 213 patients with appropriate data for analysis. Average follow-up was 4.1 years (range 1.7–6.3). Data collected included a Classification of Early-Onset Scoliosis (C-EOS) diagnosis, American Society of Anesthesiologists Physical Status (ASA-PS), major Cobb angle, construct type, clinical symptoms, and microbiology. The distribution of infection rates across all the study sites was compared. The exact p value was estimated by Monte Carlo simulation.

Results

Overall, 18% (38/213) of patients implanted with VEPTR developed infection requiring operative debridement. There were significantly different infection rates among the sites, ranging from 2.9% to 42.9% (p =.029). The average time to infection was 70 days (range 8e236) after the infecting procedure. The majority of infections were due to gram-positive bacteria (80%, 44/55), the most prevalent being methicillin-sensitive Staphylococcus aureus (45%, 25/55). There were 20 patients (53%, 20/38) with either partial or complete implant removal to resolve infection; however, only 3 of 38 (8%) of these resulted in abandonment of VEPTR treatment. There was no difference in infection rate across the primary C-EOS diagnosis categories (p =.21) or based on ASA score (p =.53). After controlling for study site, the odds ratio of an infection following an implant procedure versus an expansion was 2.8 (p =.002). There was no difference in the odds ratio of an infection between the other procedure types (implant, expansion, exchange/revision).

Conclusions

There were significant differences in infection rates between sites. The variability in infection rate indicates a need for guided efforts to standardize best practices for infection control in VEPTR surgery.

Level of Evidence

III, therapeutic study.

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Authors and Affiliations

  1. University of Colorado, Children’s Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA

    Sumeet Garg MD, Micaela Cyr BA, Tricia St. Hilaire MPH & Patrick Carry BA

  2. Children’s Spine Study Group, P.O. Box 397, Valley Forge, PA, 19481, USA

    Tara Flynn BA, Michael Glotzbecker MD, John T. Smith MD, Jeffrey Sawyer MD, FAAOS, Joshua Pahys MD, Scott Luhmann MD, John M. Flynn MD, Ron El-Hawary MD, MSc, FRCS(C) & Michael Vitale MD, MPH

  3. Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA

    Michael Glotzbecker MD

  4. Primary Children’s Medical Center, 100 North Mario Capecchi Drive, Salt Lake City, UT, 84113, USA

    John T. Smith MD

  5. University of Tennessee, Campbell Clinic, 1211 Union Avenue, Memphis, TN, 38104, USA

    Jeffrey Sawyer MD, FAAOS

  6. Shriners Hospital for Children, 3551 North Broad Street, Philadelphia, PA, 19140, USA

    Joshua Pahys MD

  7. Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 63110, USA

    Scott Luhmann MD

  8. The Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA

    John M. Flynn MD

  9. IWK Health Centre, 5980 University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada

    Ron El-Hawary MD, MSc, FRCS(C)

  10. Children’s Hospital of New York, 3959 Broadway, New York, NY, 10032, USA

    Michael Vitale MD, MPH

Authors
  1. Sumeet Garg MD
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  2. Micaela Cyr BA
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  3. Tricia St. Hilaire MPH
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  4. Tara Flynn BA
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  5. Patrick Carry BA
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  6. Michael Glotzbecker MD
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  7. John T. Smith MD
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  8. Jeffrey Sawyer MD, FAAOS
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  9. Joshua Pahys MD
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  10. Scott Luhmann MD
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  11. John M. Flynn MD
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  12. Ron El-Hawary MD, MSc, FRCS(C)
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  13. Michael Vitale MD, MPH
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Corresponding author

Correspondence to Sumeet Garg MD.

Additional information

This study was approved by the Colorado Multiple Institutional Review Board (approved protocol number 11-1248).

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Garg, S., Cyr, M., Hilaire, T.S. et al. Variability of Surgical Site Infection With VEPTR at Eight Centers: A Retrospective Cohort Analysis. Spine Deform 4, 59–64 (2016). https://doi.org/10.1016/j.jspd.2015.07.009

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  • DOI: https://doi.org/10.1016/j.jspd.2015.07.009

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