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Postoperative Spine and VEPTR Infections in Children: A Case-Control Study

Farley, Frances A. MD*; Li, Ying MD*; Gilsdorf, Janet R. MD; VanderHave, Kelly L. MD*; Hensinger, Robert N. MD*; Speers, Michele BSN*; Childers, David MS; Caird, Michelle S. MD*

Journal of Pediatric Orthopaedics: January 2014 - Volume 34 - Issue 1 - p 14–21
doi: 10.1097/BPO.0b013e3182a0064d

Background: Surgical site infection (SSI) after pediatric scoliosis surgery is a major cause of morbidity. We compared the odds ratios of various potential risk factors for infection among patients who developed a deep SSI following spinal deformity surgery and those who remained infection free.

Methods: This was a case-control study, not a matched study. More noninfection cases (50) than infection cases (20) were selected because more were available. Twenty children with a deep SSI after scoliosis surgery were compared with 50 similar children who did not develop a deep SSI. Fourteen perioperative factors were examined in both the groups.

Results: Of the 20 patients who had a deep SSI, 14 had neuromuscular scoliosis. In the infected group, 6 patients had undergone vertical expandable prosthetic titanium rib placement, 2 had undergone growing rod insertion, and 12 had undergone posterior spinal fusion. Eighteen patients developed a SSI within 1 year of the operation and 2 patients presented with a SSI >1 year after surgery. Sixteen patients had positive cultures. Majority were skin flora: coagulase-negative Staphylococcus (8) and Propionibacterium acnes (4). Both patients with tracheostomies had Enterococcus faecalis infections. When comparing the 20 patients with deep SSI to the 50 controls, increased preoperative Cobb angle (P=0.011), increased postoperative Cobb angle (P=0.0043), nonambulatory status (P=0.0002), and increased length of stay (P=0.015) were associated with significantly increased odds of infection.

Conclusions: Our study shows that patients with neuromuscular scoliosis are at higher risk of developing a deep SSI after spinal deformity surgery. Skin flora is a common cause of deep SSI. We have now instituted a standard skin preparation protocol to include alcohol and chlorhexidine washes the night before and the morning of surgery. We have altered our prophylactic antibiotic regimen to cover skin flora in all patients and gastrointestinal flora in patients with a tracheostomy. We have counseled the families of nonambulatory children with large neuromuscular curves regarding the significantly increased odds of postoperative deep SSI.

Level of Evidence: Level III.

Departments of *Orthopaedic Surgery, Mott Children’s Hospital


Statistics, University of Michigan, Ann Arbor, MI

Supported by Departmental Grant, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.

The authors declare no conflict of interest.

Reprints: Frances A. Farley, MD, Department of Orthopaedic Surgery, University of Michigan, Mott Children’s Hospital, University of Michigan, SPC 4241, 1540 East Hospital Drive, Ann Arbor, MI 48109. E-mail:

© 2014 by Lippincott Williams & Wilkins