8 key concepts on surgical site infection for neuromuscular scoliosis spinal fusions

Surgical site infections are serious complications and have a 6 percent to 24 percent prevalence rate among patients who undergo posterior spinal fusion for neuromuscular scoliosis, according to an article in The Journal of Bone & Joint Surgery.

A group of researchers conducted a retrospective review of these patients who underwent posterior spinal fusion from 1980 to 2009. The patients were followed for two years at minimum. There were 428 patients included in the study with 74 percent treated with posterior spinal fusion alone. Average Cobb angle was 74.3 degrees.

Here are eight findings from the report:

1. There was reported deep infection in 10.3 percent of the patients — 44 patients total. A little over half of the infections occurred within three months of surgery and 73 percent had occurred within one year.

2. The infection breakdown was:

• Polymicrobial: 45 percent
• Gram-positive organisms: 59 percent
• Gram-negative organisms: 41 percent

3. There was implant removal in 58 percent of the patients with surgical site infection.

4. The SSI instance has decreased since 1980, as SSI was 20.3 percent more frequent from 1980 to 1989 than 1990 to 2009.

5. Patients with spina bifida were more likely to have a surgical site infection than patients with other diagnoses. Around 21 percent of the spina bifida patients had SSI, compared with 8.3 percent of patients with other diagnoses.

6. The patient factors associated with surgical site infection were:

• Body mass index more than 25
• Incontinence

7. Treatment factors associated with SSI were:

• Inadequate prophylactic antibiotic dosing
• Fusion length
• Pelvic fixation
• Hospital length of stay
• Other complications

The factors significantly associated with SSI were drain output and lower hemoglobin levels.

8. Drain use — superficial to the facsia — was protective if the patient didn't have spina bifida.



Source: Becker's Spine Review, 30th Dec 2014