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Surgeon Practices Regarding Infection Prevention for Pediatric Spinal Surgery

Glotzbecker, Michael P. MD*; Vitale, Michael G. MD, MPH; Shea, Kevin G. MD; Flynn, John M. MD§On behalf of the POSNA committee on the Quality, Safety, Value Initiative (QSVI)

doi: 10.1097/BPO.0b013e31829241b8

Background: A postoperative spinal infection has significant financial and emotional impact on the patient, family, and health care system. The purpose of this study is to understand approaches used by pediatric spinal surgeons with regard to infection prevention.

Methods: A survey was electronically distributed to 277 POSNA/SRS members. A total of 123 responses were obtained (44%). Eighty-one percent of participating surgeons were in academic practices. Among responders, 82% have been in practice for >10 years, and only 5% have been in practice <5 years.

Results: Sixty-four percent of surgeons responded that they knew their infection rate over the last year, and average reported rates were 1.3% and 5.3% in idiopathic and neuromuscular patients, respectively. The surgeon estimated rates were 0.5% and 4.4% in similar populations for those who did not exactly know their infection rates. Preoperatively, 50% of surgeons suggest chlrorhexidine use at home. Preoperative labs to stratify risk are obtained in 54% of neuromuscular patients and 9% of all patients. MRSA swabs and urine cultures are used variably preoperatively. IV antibiotic use before incision commonly includes not only cephalosporins (>80%), but also frequently involves vancomycin. Forty-seven percent of neuromuscular patients receive gram-negative coverage, whereas only 11% of idiopathic patients do. Skin preparation methods are highly variable among responding physicians. Vancomycin powder is used with the bone graft in 24% of all patients, with gentamycin and vancomycin used variably in idiopathic and neuromuscular patients. Policies limiting scrub wear out of the hospital and traffic in the operating room, the use of UV lights or negative pressure ventilation, and use of drains were also variable.

Conclusion: There is significant variability in the current practices of surgeons who perform spinal deformity surgery with regard to infection prevention. Such variability most likely results from a lack of good evidence and may reflect suboptimal care. This data can be used as a starting point to help design and direct multicenter studies with an ultimate goal of reducing infection after spinal deformity surgery.

Level of Evidence: Level V.

*Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA

Morgan Stanley Children’s Hospital of New York, Manhattan, NY

Intermountain Orthopaedics Idaho, Boise, ID

§Children’s Hospital of Philadelphia, Philadelphia, PA

This work is submitted on behalf of the POSNA committee on the Quality, Safety, Value Initiative (QSVI). It has been approved by POSNA leadership.

None of the authors received financial support for this study.

The authors declare no conflicts of interest.

Reprints: Michael P. Glotzbecker, MD, Department of Orthopaedic Surgery, Boston Children’s Hospital, Hunnewell, 300 Longwood Avenue, Boston, MA 02115. E-mail:

© 2013 by Lippincott Williams & Wilkins