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Does the Type of Metal Instrumentation Affect the Risk of Surgical Site Infection in Pediatric Scoliosis Surgery?

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Abstract

Study Design

Retrospective cohort study.

Objectives

To determine the association of implant metal composition with the risk of surgical site infection (SSI) following pediatric spine surgery.

Summary of Background Data

SSI is a well-described complication following pediatric spine surgery. Many risk factors have been identified in the literature, but controversy remains regarding metal composition as a risk factor.

Methods

This was a retrospective study of patients who underwent posterior spinal instrumentation procedures between January 1, 2006, and December 31, 2008, at three large children’s hospitals for any etiology of scoliosis and had at least 1 year of postoperative follow-up. Procedures included posterior spinal fusion, growth-friendly instrumentation, and revision of spinal instrumentation. The Centers for Disease Control and Prevention definition of SSI was used. A chi-squared test was performed to determine the relationship between type of metal instrumentation and development of an SSI.

Results

The study included 874 patients who underwent 1,156 total procedures. Overall, 752 (65%) procedures used stainless steel instrumentation, 238 (21%) procedures used titanium instrumentation, and the remaining 166 (14%) procedures used cobalt chrome and titanium hybrid instrumentation. The overall risk of infection was 6.1% (70/1,156) per procedure, with 5.9% (44/752) for stainless steel, 6.7% (12/238) for titanium, and 6.0% (10/166) for cobalt chrome. The multiple regression analysis found no significant differences in the metal type used between patients with and without infection (p =.886) adjusting for etiology, instrumentation to pelvis, and type of procedures. When stratified based on etiology, the multiple regression analyses also found no significant difference in SSI between two metal type groups.

Conclusions

This study found no difference in risk of infection with stainless steel, titanium, or cobalt chrome/titanium instrumentation and is adequately powered to detect a true difference in risk of SSI.

Level of Evidence

Level II, prognostic.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA

    Margaret L. Wright BS, Hiroko Matsumoto MA & Michael G. Vitale MD, MPH

  2. Children’s Hospital Los Angeles, Los Angeles, CA, USA

    David L. Skaggs MD & Regina P. Woon MPH

  3. Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Ashley Trocle BS & John M. Flynn MD

Authors
  1. Margaret L. Wright BS
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  2. David L. Skaggs MD
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  3. Hiroko Matsumoto MA
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  4. Regina P. Woon MPH
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  5. Ashley Trocle BS
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  6. John M. Flynn MD
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  7. Michael G. Vitale MD, MPH
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Corresponding author

Correspondence to Margaret L. Wright BS.

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Author disclosures

MLW (none), DLS (grants from POSNA & SRS, personal fees from Biomet & Medtronic, nonfinancial support from Growing Spine Study Group, Scoliosis Research Society, Growing Spine Foundation, Medtronic Strategic Advisory Board, personal fees from expert testimony, personal fees from Biomet, Medtronic, and Stryker, personal fees from Wolters Kluwer Health–Lippincott Williams & Wilkins, other from Medtronic, other from Stryker, Biomet, and Medtronic outside the submitted work; in addition, he has a patent Medtronic issued), HM (grants from SRS, POSNA, CWSDRF, CPIRF, other from Biomet, Medtronic, DePuy Synthes, Stryker, outside the submitted work), RPW (none), AT (none), JMF (other from Biomet, other from LWW, outside the submitted work), MGV (grants from SRS, POSNA, CWSDRF, other from Biomet, Medtronic, DePuy Synthes, Stryker, other from Biomet, outside the submitted work).

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Wright, M.L., Skaggs, D.L., Matsumoto, H. et al. Does the Type of Metal Instrumentation Affect the Risk of Surgical Site Infection in Pediatric Scoliosis Surgery?. Spine Deform 4, 206–210 (2016). https://doi.org/10.1016/j.jspd.2015.11.002

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  • DOI: https://doi.org/10.1016/j.jspd.2015.11.002

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