Surgical site infections in pediatric spinal surgery after implementation of a quality assurance program
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Surgical site infections in pediatric spinal surgery after implementation of a quality assurance program Bradley Hammoor1,3 · Hiroko Matsumoto1,2,3 · Gerard Marciano1 · Lucas Dziesinski1,3 · Kevin Wang1,3 · Benjamin D. Roye1,3 · David P. Roye1,3 · Michael G. Vitale1,3 Received: 20 March 2020 / Accepted: 10 August 2020 © Scoliosis Research Society 2020
Abstract Study Design Retrospective cohort study. Objective To assess the effectiveness of two infection-reducing programs in mitigating the incidence of post-operative surgical site infections (SSI) in pediatric patients after spinal deformity surgery at our institution. Summary of background data Infections following spinal deformity surgery are associated with higher morbidity as well as significantly increased healthcare costs. SSI in patients with neuromuscular etiologies is especially high, exceeding 8 percent for myelodysplasia patients and 6 percent for cerebral palsy patients. Methods Manual chart review was conducted for 1934 pediatric spine procedures in 1200 patients at our institution between 2008 and 2018. Patients between the ages of 0 and 21 having any spinal surgical procedure including lengthening of growing rods were included. Results Institution of two separate infection-reducing programs reduced risk of SSI in this population by 65.4%, when adjusted for age and number of instrumentation levels (risk ratio [RR] = 0.3, 95% confidence interval [CI] = 0.2; 0.6, p = 0.001). Patients undergoing Initial Instrumentation demonstrated 68.8% less risk of SSI compared to those who had other types of surgical procedures, after adjusting for age and the number of level instrumented (RR = 0.3, 95% CI 0.2; .6, p = 0.002). It was observed that the effect of each of these infection-reducing programs diminished with time. This effect was also observed with prior programs implemented at our institution. Conclusion The incidence of SSI decreased following the implementation of two infection-reducing programs especially in patients undergoing Initial Instrumentation procedures. However, time-series analysis suggests these programs may have maximal effect immediately following institution that diminishes with time. Level of evidence Level III. Keywords Surgical site infection (SSI) · Spinal deformity surgery · Infection-reducing programs · Health-care-associated infections (HAIs) · The Comprehensive Unit-Based Safety Program (CUSP) · Solutions for Patient Safety (SPS)
Introduction
* Hiroko Matsumoto [email protected] 1
Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, USA
2
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
3
Department of Pediatric Orthopedic Surgery, Morgan Stanley Children’s Hospital of New York Presbyterian, Columbia University Irving Medical Center, New York, USA
Health-care-associated infections (HAIs) impose a significant burden on both the patient and the healthcare system. For patients and providers, HAIs cause frequ
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