785 Risk Factors for Pediatric Spine Fusion Deep Surgical Site Infection

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Dean Blumberg, MD , University of California Davis Children's Hospital, Sacramento, CA
Jason Beckstead, PhD , University of South Florida, Tampa, FL
Tammy Trottier, RN, BSN , Shriners Hospitals for Children, Tampa, FL
Background: Children with diverse underlying conditions undergo spine fusion, and these procedures may be performed by a variety of techniques.  Spine fusion deep surgical site infection may result in significant patient impact, such as re-operation, prolonged antimicrobial therapy, and loss of function.

Objective: Define patient and procedure risk factors for deep surgical site infection following spine fusion.

Methods: Data were collected for all patients undergoing spine fusion in a 22 pediatric hospital system between April 2004 and April 2008, including patient characteristics, procedure characteristics, and the occurrence of deep surgical site infection in the year following the procedure.  The National Healthcare Safety Network definition of deep surgical site infection was used.

Results: 3,573 procedures were performed over the 4 year period.  The mean age of the patients was 13 years 11 months, 68.2% were female, and a mean of 9.85 vertebral levels were fused.  Of the procedures, 83.6% were posterior spine fusion only, 7.4% were anterior spine fusion only, and 9.1% were anterior and posterior spine fusions.  There were 114 deep surgical site infections (3.2%).  Males had an increased rate of infection compared to females (4.5% vs. 2.6%, p<0.01).  The highest rate of infection occurred in patients with neuromuscular scoliosis (7.6%), followed by congenital scoliosis (3.0%); patients with idiopathic scoliosis had the lowest infection rate (1.5%) [p<0.01].  Infection rates increased with higher ASA (American Society of Anesthesiologists) scores:  1.2% for ASA 1, 2.9% for ASA 2, 6.4% for ASA 3, and 35.3% for ASA 4 (p<0.01).  Patients with more vertebral levels fused had higher infection rates (p<0.01).  Infection rate did not vary by patient age, procedural approach (anterior, posterior, or both), or length of procedure.

Conclusions: Higher rates of spine fusion deep surgical site infection occurred in pediatric patients who were male, had neuromuscular or congenital scoliosis, had higher ASA scores, and with more vertebral levels addressed.