Hiroko Matsumoto1,2, Lisa Bonsignore-Opp3, Shay I Warren4, Bradley T Hammoor3, Michael J Troy5, Kody K Barrett6, Brendan M Striano5, Benjamin D Roye3, Lawrence G Lenke3, David L Skaggs7, Michael P Glotzbecker8, John M Flynn9, David P Roye3, Michael G Vitale3. 1. Department of Orthopedics & Sports Medicine, Boston Children's Hospital, Boston, MA, 02115, USA. Hm2174@cumc.columbia.edu. 2. Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, 02115, USA. Hm2174@cumc.columbia.edu. 3. Department of Orthopaedic Surgery, Columbia University Irving Medical Center, 3959 Broadway Suite 800 North, New York, NY, 10032, USA. 4. Department of Orthopaedic Surgery, Stanford University, 430 Broadway, Pavilion C, Redwood City, CA, 94063, USA. 5. Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA. 6. Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA. 7. Spine Center, Cedars-Sinai Medical Center, 444 S San Vicente Blvd Suite #901, Los Angeles, CA, 90048, USA. 8. Department of Orthopaedic Surgery, University Hospital Cleveland Medical Center, Rainbow Babies and Children's Hospital, 201 Adelbert Road, Cleveland, OH, 44106, USA. 9. Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA, 19104, USA.
Abstract
BACKGROUND: Identifying beneficial preventive strategies for surgical-site infection (SSI) in individual patients with different clinical and surgical characteristics is challenging. The purpose of this study was to investigate the association between preventive strategies and patient risk of SSI taking into consideration baseline risks and estimating the reduction of SSI probability in individual patients attributed to these strategies. METHODS: Pediatric patients who underwent primary, revision, or final fusion for their spinal deformity at 7 institutions between 2004 and 2018 were included. Preventive strategies included the use of topical vancomycin, bone graft, povidone-iodine (PI) irrigations, multilayered closure, impermeable dressing, enrollment in quality improvement (QI) programs, and adherence to antibiotic prophylaxis. The CDC definition of SSI as occurring within 90 days postoperatively was used. Multiple regression modeling was performed following multiple imputation and multicollinearity testing to investigate the effect of preventive strategies on SSI in individual patients adjusted for patient and surgical characteristics. RESULTS: Univariable regressions demonstrated that enrollment in QI programs and PI irrigation were significantly associated, and topical vancomycin, multilayered closure, and correct intraoperative dosing of antibiotics trended toward association with reduction of SSI. In the final prediction model using multiple regression, enrollment in QI programs remained significant and PI irrigation had an effect in decreasing risks of SSI by average of 49% and 18%, respectively, at the individual patient level. CONCLUSION: Considering baseline patient characteristics and predetermined surgical and hospital factors, enrollment in QI programs and PI irrigation reduce the risk of SSI in individual patients. Multidisciplinary efforts should be made to implement these practices to increase patient safety. LEVEL OF EVIDENCE: Prognostic level III study.
BACKGROUND: Identifying beneficial preventive strategies for surgical-site infection (SSI) in individual patients with different clinical and surgical characteristics is challenging. The purpose of this study was to investigate the association between preventive strategies and patient risk of SSI taking into consideration baseline risks and estimating the reduction of SSI probability in individual patients attributed to these strategies. METHODS: Pediatric patients who underwent primary, revision, or final fusion for their spinal deformity at 7 institutions between 2004 and 2018 were included. Preventive strategies included the use of topical vancomycin, bone graft, povidone-iodine (PI) irrigations, multilayered closure, impermeable dressing, enrollment in quality improvement (QI) programs, and adherence to antibiotic prophylaxis. The CDC definition of SSI as occurring within 90 days postoperatively was used. Multiple regression modeling was performed following multiple imputation and multicollinearity testing to investigate the effect of preventive strategies on SSI in individual patients adjusted for patient and surgical characteristics. RESULTS: Univariable regressions demonstrated that enrollment in QI programs and PI irrigation were significantly associated, and topical vancomycin, multilayered closure, and correct intraoperative dosing of antibiotics trended toward association with reduction of SSI. In the final prediction model using multiple regression, enrollment in QI programs remained significant and PI irrigation had an effect in decreasing risks of SSI by average of 49% and 18%, respectively, at the individual patient level. CONCLUSION: Considering baseline patient characteristics and predetermined surgical and hospital factors, enrollment in QI programs and PI irrigation reduce the risk of SSI in individual patients. Multidisciplinary efforts should be made to implement these practices to increase patient safety. LEVEL OF EVIDENCE: Prognostic level III study.
Authors: Ronald P Caputo; Ankush Goel; Michael Pencina; David J Cohen; Neal S Kleiman; Chen-Hsing Yen; Ron Waksman; Paul Tolerico; Gaurav Dhar; Paul Gordon; Richard G Bach; John J Lopez Journal: Am J Cardiol Date: 2012-05-04 Impact factor: 2.778
Authors: Kristen A Ban; Joseph P Minei; Christine Laronga; Brian G Harbrecht; Eric H Jensen; Donald E Fry; Kamal M F Itani; E Patchen Dellinger; Clifford Y Ko; Therese M Duane Journal: J Am Coll Surg Date: 2016-11-30 Impact factor: 6.113
Authors: Jaime A Gomez; Alexandra Grzywna; Patricia E Miller; Lawrence I Karlin; Sumeet Garg; James O Sanders; Peter F Sturm; Paul D Sponseller; Jacques L D'Astous; Michael P Glotzbecker Journal: J Pediatr Orthop Date: 2017-12 Impact factor: 2.324
Authors: Michael G Vitale; Matthew D Riedel; Michael P Glotzbecker; Hiroko Matsumoto; David P Roye; Behrooz A Akbarnia; Richard C E Anderson; Douglas L Brockmeyer; John B Emans; Mark Erickson; John M Flynn; Lawrence G Lenke; Stephen J Lewis; Scott J Luhmann; Lisa M McLeod; Peter O Newton; Ann-Christine Nyquist; B Stephens Richards; Suken A Shah; David L Skaggs; John T Smith; Paul D Sponseller; Daniel J Sucato; Reinhard D Zeller; Lisa Saiman Journal: J Pediatr Orthop Date: 2013 Jul-Aug Impact factor: 2.324