title: Operative and clinical markers of deep wound infection after spine fusion in children with cerebral palsy.
abstract: BACKGROUND
  Infection after spine fusion for neuromuscular scoliosis has been shown to range from 4.2% to 20.0% prevalence. Although there are studies, which have examined deep wound infection and spine fusion surgery as well as risk factors for deep wound infection, there are limited studies evaluating clinical and radiographic factors associated with this complication. We aimed to determine the clinical and operative factors associated with deep wound infection after spine fusion in pediatric patients with cerebral palsy (CP).
  
  
  METHODS
  Medical records of 236 pediatric patients, aged between 5.6 and 21 years (mean=13.8 ± 3.4), with CP who underwent spine fusion from 1995 to 2006 were reviewed. Of these, 22 patients had deep wound infection. To assess the differences in clinical, radiographic, and other predisposing factors, we used χ statistic and Fisher exact, and to determine the predisposing factors of deep wound infection, we used binomial regression model.
  
  
  RESULTS
  The period prevalence of deep wound infection was 9.3%. In the unadjusted model, body weight, residual postoperative Cobb angle, length of hospitalization, packed red blood cells, and skin breakdown were the factors significantly associated with deep wound infection (P<0.05). After controlling for confounding, skin breakdown due to the instrumentation and residual postoperative Cobb angle were the 2 most potent markers of deep wound infection. There was a significant 4% increased risk of deep wound infection for 1-degree increase in the residual Cobb angle from the noncase mean residual Cobb angle of 23.69 degrees (adjusted risk ratio=1.04; 95% confidence interval, 1.01-1.08). Likewise, compared with those without skin breakdown, those with skin breakdown were 12 times as likely to develop deep wound infection (risk ratio=12.92; 95% confidence interval, 1.00-172.00).
  
  
  CONCLUSIONS
  Residual postoperative Cobb angle and skin breakdown due to unit rod instrumentation were the 2 most significant predisposing factors to deep wound infection. Other factors included body weight, packed red blood cells, and length of hospitalization. As the overall prevalence of deep wound infection is relatively high in CP patients after spine fusion, and considering the cost of hospitalization and other related comorbidities, surgeons should recognize these predisposing parameters to prevent deep wound infection in CP patients while correcting curve deformities.
  
  
  METHODS
  Level III retrospective study.
authors.affiliation: Department of Orthopaedics, A.I. duPont Hospital for Children, Wilmington, DE 19803, USA.
authors.forename: Mohamed Hassan
authors.initials: MH
authors.lastname: Mohamed Ali
authors.forename: Durga N
authors.initials: DN
authors.lastname: Koutharawu
authors.forename: Freeman
authors.initials: F
authors.lastname: Miller
authors.forename: Kirk
authors.initials: K
authors.lastname: Dabney
authors.forename: Peter
authors.initials: P
authors.lastname: Gabos
authors.forename: Suken
authors.initials: S
authors.lastname: Shah
authors.forename: Larry
authors.initials: L
authors.lastname: Holmes
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult