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Risk Factors for Surgical Site Infections After Pediatric Spine Operations

Croft, Lindsay D. MS*; Pottinger, Jean M. MA, RN; Chiang, Hsiu-Yin PhD, MS‡,§; Ziebold, Christine S. MD, PhD, MPH; Weinstein, Stuart L. MD; Herwaldt, Loreen A. MD, FIDSA†,‡,§

doi: 10.1097/BRS.0000000000000693
Surgery
Buy
SDC

Study Design. Matched case-control study.

Objective. To identify modifiable risk factors for surgical site infections (SSIs) after pediatric spinal fusion.

Summary of Background Data. The number of SSIs after pediatric spinal fusions increased.

Methods. Between July 2001 and July 2010, 22 of 598 pediatric patients who underwent spinal fusion at a university hospital acquired SSIs. Each patient with an SSI was matched with 2 controls by procedure date. Bivariable and multivariable analyses were used to identify risk factors for SSIs and outcomes of SSIs.

Results. Gram-negative organisms caused more than 50% of the SSIs. By multivariable analysis, neuromuscular scoliosis (odds ratio [OR] = 20.8; 95% confidence interval [CI], 3.1–889.5; P < 0.0001) and weight-for-age at the 95th percentile or higher (OR = 8.6; 95% CI, 1.2–124.9; P = 0.02) were preoperative factors associated with SSIs. Blood loss (OR = 1.0; 95% CI, 1.0–1.0; P = 0.039) and allografts and allografts in combination with other grafts were operative risk factors for SSIs. The final overall risk model for SSIs was weight-for-age at the 95th percentile or higher (OR = 4.0; 95% CI, 1.4–∞; P = 0.037), American Society of Anesthesiologists score 3 or more (OR = 3.8; 95% CI, 1.6–∞; P = 0.01), and prolonged operation duration (OR = 1.0/min increase; 95% CI, 1.0–1.0; P = 0.004). SSIs were associated with 2.8 days of additional postoperative length of stay (P = 0.02). Neuromuscular scoliosis was the only factor significantly associated with hospital readmission (OR = 23.6; 95% CI, 3.8–147.3; P = 0.0007).

Conclusion. Our results suggest that pediatric patients undergoing spinal fusion might benefit from antimicrobial prophylaxis that covers gram-negative organisms. Surgical duration, graft implantation, and blood loss are potentially modifiable operative risk factors. Neuromuscular scoliosis, high weight-for-age, and American Society of Anesthesiologists scores 3 or more may help surgical teams identify patients at high risk for SSI.

Level of Evidence: 4

This case-control study of children undergoing spinal fusion identified surgical duration, graft implantation, and blood loss as potentially modifiable risk factors and neuromuscular scoliosis, weight-for-age, and American Society for Anesthesiology scores 3 or more as factors that may help staff identify patients at risk for surgical site infections. Antimicrobial prophylaxis covering gram-negative organisms might be beneficial.

*Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore

Clinical Quality, Safety, and Process Improvement, University of Iowa Hospitals and Clinics, Iowa City

Department of Epidemiology, University of Iowa College of Public Health, Iowa City; and Departments of

§Internal Medicine

Pediatrics, and

Orthopedics, University of Iowa Carver College of Medicine, Iowa City.

Address correspondence and reprint requests to Loreen A. Herwaldt, MD, FIDSA, Department of Internal Medicine, The University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242; E-mail: loreen-herwaldt@uiowa.edu

Acknowledgment date: March 19, 2014. First revision date: September 25, 2014. Second revision date: October 14, 2014. Acceptance date: October 29, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: travel/accommodations/meeting expenses, board membership, grants.

© 2015 by Lippincott Williams & Wilkins