title: Deep wound infection following pediatric scoliosis surgery: incidence and analysis of risk factors.
abstract: BACKGROUND
  Deep wound infection after spinal surgery is a severe complication that often requires prolonged medical and surgical management. It can compromise the outcome of the deformity correction, especially in patients requiring surgical intervention with subsequent removal of implants. Ascertaining the incidence and risk factors leading to infection may help to prevent this problem.
  
  
  METHODS
  We reviewed the hospital charts of all patients who underwent spinal deformity correction from 1996 to 2005.
  
  
  RESULTS
  In all, 227 patients were identified (139 idiopathic, 57 neuromuscular, 8 syndromic, 6 congenital, 17 other); 191 patients were treated with posterior instrumentation and fusion, 11 with anterior-only procedures and 24 with combined anterior and posterior procedures. Final follow-up ranged from 1 to 9.5 years. Infection developed in 14 patients. The overall incidence of infection was 6.2%. Drainage and back pain were the most common presenting symptoms. The incidence of infection was higher among patients with nonidiopathic diagnoses (risk ratio [RR] 8.65, p < 0.001). Use of allograft bone was associated with a higher rate of infection (RR 9.66, p < 0.001) even when stratified by diagnosis (nonidiopathic diagnoses, RR 7.6, p = 0.012). Higher volume of instrumentation was also a risk factor for infection (p = 0.022). Coagulase-negative Staphyloccocus was the most commonly identified organism, followed by Propionibacterium acnes and Pseudomonas.
  
  
  CONCLUSIONS
  Development of infection following scoliosis surgery was found to be associated with several risk factors, including a nonidiopathic diagnosis, the use of allograft and a higher volume of instrumentation. Preventative measures addressing these factors may decrease the rate of infection.
authors.affiliation: Department of Surgery, King Abdul Aziz Medical Center, Riyadh, Saudi Arabia.
authors.forename: Sami
authors.initials: S
authors.lastname: Aleissa
authors.forename: David
authors.initials: D
authors.lastname: Parsons
authors.forename: John
authors.initials: J
authors.lastname: Grant
authors.forename: James
authors.initials: J
authors.lastname: Harder
authors.forename: Jason
authors.initials: J
authors.lastname: Howard
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D016268:Internal Fixators / Q000009:adverse effects; D008159:Lumbar Vertebrae; D008297:Male; D012307:Risk Factors; D012600:Scoliosis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D013904:Thoracic Vertebrae