Deep Wound Infections After Pediatric Scoliosis Surgery

Sina Pourtaheri; Freeman Miller; Kirk Dabney; Suken A Shah; Susan Dubowy; Laurens Holmes

doi:10.1016/j.jspd.2015.04.003

Deep Wound Infections After Pediatric Scoliosis Surgery

Spine Deform. 2015 Nov;3(6):533-540. doi: 10.1016/j.jspd.2015.04.003. Epub 2015 Oct 28.

Authors

Sina Pourtaheri¹, Freeman Miller², Kirk Dabney¹, Suken A Shah¹, Susan Dubowy¹, Laurens Holmes¹

Affiliations

¹ Department of Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, P.O. Box 269, Wilmington, DE 19899, USA.
² Department of Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, P.O. Box 269, Wilmington, DE 19899, USA. Electronic address: fmiller@nemours.org.

PMID: 27927555
DOI: 10.1016/j.jspd.2015.04.003

Abstract

Study design: Retrospective clinical and radiographic review.

Objective: The purpose of this study was to evaluate the characteristics of deep wound infection, as well as the potential factors that correlate to surgical site infection (SSI) in spine deformity surgery.

Summary of background data: Preventing SSIs in pediatric spinal deformity surgery is a crucial task. Recent data have shown that antibiotic-loaded allograft and properly timed preoperative antibiotic administration decrease SSIs. However, there remain controversies over the appropriate preoperative antibiotic selection.

Methods: We reviewed 851 spinal deformity surgeries that took place at a single institution from 2006 to 2010. In particular, preoperative and postoperative characteristics of the deep wound infections were evaluated.

Results: Twenty-four patients had SSIs. The mean age at surgery in the infected cohort was 14 years, mean length of surgery was 8 hours, and median estimated blood loss was 2,482 mL (%EBV: 66%). Approximately 67% of the infected patients had bowel/bladder incontinence, and 71% had prolonged intravenous access perioperatively. According to culture results, the most effective antibiotic to treat the infections was vancomycin. Preoperative antibiotics were administered within 30 minutes of incision (hospital protocol) in only 12.5% (p = .001) and within 1 hour of incision in 54% of the cases. The wound status within 3 days of surgery is as follows: 38% intact, 29% significant wound drainage, and 33% wound dehiscence. Methicillin-resistant Staphylococcus aureus (MRSA) and oxacillin-resistant Staphylococcus epidermidis were associated with intact wounds, whereas gram-negative pathogens were seen in dehisced or draining wounds (p < .001).

Conclusions: The authors showed that their cohort of patients with infection had a high rate of draining wounds, MRSA infections, administration of antibiotics more than 1 hour ahead of incision, and prolonged need for intravenous access after surgery. Efforts to mitigate these associations by using vancomycin prophylactically, doing meticulous wound closure to prevent drainage or dehiscence, and delivering antibiotics at an optimal time ahead of incision may lead to a decrease in infection rates in pediatric spinal surgery. Future prospective studies will be needed to validate this.

Keywords: Antibiotics; Idiopathic scoliosis; Neuromuscular scoliosis; Pathogens; Pediatric scoliosis; Surgical site infections.