Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Wound Infections After Surgery for Neuromuscular Scoliosis: Risk Factors and Treatment Outcomes

Master, Daniel L, MD; Connie, Poe-Kochert, RN, CNP; Jochen, Son-Hing, MD, FRCS (C); Armstrong, Douglas G, MD, FRCS (C); Thompson, George H., MD

doi: 10.1097/BRS.0b013e3181db7afe
Deformity
Buy

Study Design. Retrospective, case-control study.

Objective. Determine risk factors for postoperative wound infections after surgery for neuromuscular scoliosis as well as the causative organisms and the results of treatment.

Summary of Background Data. Wound infection after surgery for neuromuscular scoliosis is more common than that for idiopathic scoliosis. A variety of potential risk factors have been identified, but few have demonstrated statistical significance.

Methods. The Pediatric Orthopedic Spine Database identified 151 patients with neuromuscular scoliosis who underwent surgery and had a follow-up of minimum of 2 years. A total of eight patients (5.3% prevalence) developed a postoperative wound infection. Nine patients without an infection were matched by year and type of surgery, for each patient with an infection and selected as controls (n = 72). Preoperative, intraoperative, and postoperative factors were analyzed for an association with wound infection by using stepwise logistic regression. In addition, causative organisms as well as the methods and results of treatment were recorded for each patient.

Results. The control group consisted of 32 males and 40 females with a mean age of 13.3 years (range, 7–21 years) and a mean follow-up of 4.6 years (range, 2.0–20.9 years) at surgery. The infection group (n = 8) consisted of four males and four females with a mean age of 12.5 years (range, 11–14 years) and a mean follow-up of 5.1 year (range, 2.0–12.3 years) at surgery. There were five early and three late wound infections. The presence of a ventriculoperitoneal shunt before surgery was the only factor statistically associated with an increased risk for wound infection (P < 0.01). In addition, infection was associated with pseudarthrosis (P < 0.01) and an increased length of hospitalization (P < 0.01). The most common causative species was staphylococcus and the majority (88%) of infections required surgical intervention with a mean of 2.1 debridements (range, 1–4 debridements).

Conclusions. The presence of a ventriculoperitoneal shunt is a statistically significant risk factor for wound infection after corrective surgery for neuromuscular scoliosis. Wound infection is associated with pseudarthrosis and prolonged hospitalization.

Level of Evidence. III

We analyzed 151 consecutive patients with neuromuscular scoliosis who underwent corrective surgery. Eight patients (5.3%) developed a postoperative infection. A selected control group (n = 72) of nine patients per infected patient matched by year and type of surgery were used as a control group to determine potential risks. Infections were associated with the presence of a ventriculoperitoneal shunt, pseudarthrosis, and a prolonged hospitalization.

From the Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH.

Address correspondence and reprint requests to George H. Thompson, MD, Rainbow Babies and Children's Hospital, Department of Orthopaedic Surgery, 11100 Euclid Avenue, Cleveland, OH 44106; E-mail: ght@po.cwru.edu.

Acknowledgment date: July 15, 2009. First revision date: October 15, 2009. Second Revision date: December 24, 2009. Acceptance date: January 25, 2010.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

Supported by the Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Cleveland, OH.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

The study was approved by the institutional review board of the Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH.

© 2011 Lippincott Williams & Wilkins, Inc.