Surgical site infection prevention protocol for pediatric spinal deformity surgery: does it make a difference?
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Surgical site infection prevention protocol for pediatric spinal deformity surgery: does it make a difference? Connie Poe‑Kochert1,2 · Jilan L. Shimberg2 · George H. Thompson1,2 · Jochen P. Son‑Hing1,2 · Christina K. Hardesty1,2 · R. Justin Mistovich1,2 Received: 4 January 2020 / Accepted: 9 April 2020 © Scoliosis Research Society 2020
Abstract Study design Retrospective. Objective Can a standardized, hospital-wide care bundle decrease surgical site infection (SSI) rate in pediatric spinal deformity surgery? Summary of background data SSI is a major concern in pediatric spinal deformity surgery. Methods We performed a retrospective review of our primary scoliosis surgeries between 1999 and 2017. In 2008, we implemented a standardized infection reduction bundle. Interventions included preoperative nares screening for methicillinresistant staphylococcus aureus or methicillin-sensitive Staphylococcus aureus 2 weeks preoperatively, and treatment with intranasal mupirocin when positive, a bath or shower the night before surgery, a preoperative chlorohexidine scrub, timing of standardized antibiotic administration, standardized intraoperative re-dosing of antibiotics, limiting operating room traffic, and standardized postoperative wound care. In 2011, we added intrawound vancomycin powder at wound closure. Our inclusion criteria were patients 21 years of age or less with idiopathic, neuromuscular, syndromic, or congenital scoliosis who had a primary spinal fusion or a same day anterior and posterior spine fusion with segmental spinal instrumentation of six levels or more. We compared the incidence of early (within 90 days of surgery) and late (> 91 days) SSI during the first postoperative year. Results There were 804 patients who met inclusion criteria: 404 in the non-bundle group (NBG) for cases prior to protocol change and 400 in the bundle group (BG) for cases after the protocol change. Postoperatively, there were 29 infections (7.2% of total cases) in the NBG: 9 early (2.2%) and 20 late (5.0%) while in the BG there were only 10 infection (2.5%): 6 early (1.5%) and 4 late (1.0%). The reduction in overall SSIs was statistically significant (p = 0.01). There was a trend toward decreased early infections in the BG, without reaching statistical significance (p = 0.14). Conclusion Standardized care bundles appear effective in reducing the incidence of postoperative pediatric spine SSIs. Level of evidence Level III. Keywords Scoliosis · Surgical site infection · SSI · Antibiotics · Bundle
Introduction Surgical site infections (SSI) continue to be a significant concern in pediatric spinal deformity surgery. The associated costs of an infection can be overwhelming. A single SSI * R. Justin Mistovich [email protected] 1
Rainbow Babies and Children’s Hospital, University Hospitals Cleveland Medical Center, Cleveland, USA
Case Western Reserve University School of Medicine, Cleveland, USA
2
after pediatric spine deformity surgery can generate mean hospital charges of $154,537 [1]. This is in add
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