Surgical site infection in pediatric spinal fusion surgery revisited: Outcome and risk factors after preventive bundle implementation

Abstract

Background: Surgical site infections (SSI) contribute to significant morbidity, mortality, length of stay, and financial burden. We sought to evaluate the incidence and risk factors of surgical site infection following pediatric spinal fusion surgery in patients for whom standard perioperative antibiotic prophylaxis and preventive strategies have been implemented. Methods: We conducted a retrospective study of children aged <18 years who underwent spinal fusion surgery from January 2017 to November 2021 at a quaternary academic pediatric medical center. Univariable analysis was used to evaluate associations between potential risk factors and SSI. Results: Of 1111 patients, 752 (67.6%) were female; median age was 14.2 years. SSI occurred in 14 patients (1.3%). Infections were superficial incisional (n = 2; 14.3%), deep incisional (n = 9; 64.3%), and organ/space (n = 3; 21.4%). Median time to SSI was 14 days (range, 8 to 45 days). Staphylococcus aureus and Escherichia coli were the most frequently-isolated bacteria. Potential risk factors for SSIs included low body weight (Odds ratio (OR) 0.96, 95% confidence interval (CI) 0.93–0.99, p = 0.026), ASA classification of ≥3 (OR 24.53, 95%CI 3.20–188.22, p = 0.002), neuromuscular scoliosis (OR 3.83, 95%CI 3.82–78.32, p<0.001), prolonged operative time (OR 1.56, 95%CI 1.28–1.92, p<0.001), prolonged anesthetic time (OR 1.65, 95%CI 1.35–2.00, p<0.001), administration of prophylactic antibiotic ≥60 min before skin incision (OR 11.52, 95%CI 2.34–56.60, p = 0.003), and use of povidone-iodine alone for skin preparation (OR 5.97, 95%CI 1.27–28.06, p = 0.024). Conclusion: In the context of a robust bundle for SSI prevention; low body weight, ASA classification of ≥3, neuromuscular scoliosis, prolonged operative and anesthetic times, administration of prophylactic antibiotic >60 min before skin incision, and use of povidone-iodine alone for skin preparation increased the risk of SSI. Administration of prophylactic antibiotic within 60 min of skin incision, strict adherence to high-risk preventive protocol, and use of CHG-alcohol could potentially reduce the rate of SSI.