title: Incidence and risk factors for early wound complications after spinal arthrodesis in children: analysis of 30-day follow-up data from the ACS-NSQIP.
abstract: METHODS
  Retrospective review of prospectively collected data.
  
  
  OBJECTIVE
  To determine the incidence and risk factors for 30-day wound complication after spinal arthrodesis in pediatric patients.
  
  
  BACKGROUND
  Although multiple prior studies have reported on wound complications in pediatric spine, the majority have been single-center retrospective series.
  
  
  METHODS
  The National Surgical Quality Improvement Program (NSQIP) employs on-site personnel to prospectively collect 30-day morbidity data from 50 pediatric centers. Year 2012 was the first year of enrollment, and 1915 cases with thoracic or lumbar spinal fusion were included. Patients were divided into cohorts of those with and without a wound complication, with univariate and multivariate analyses used to identify risk factors. A P value of less than 0.05 was considered significant.
  
  
  RESULTS
  Wound complications occurred in 67 patients (3.5%). The incidence was significantly higher in patients with congenital (4.35%) or neuromuscular (4.67%) diagnoses, as opposed to idiopathic (2.7%) or infantile (1.61%). Procedures with fusions extending to the pelvis (9.91%) or an osteotomy (4.99%) were associated with higher risk. Longer hospital lengths of stay, increased operative time, increased patient body mass index, and patients with cardiac, gastrointestinal, neurological, or pulmonary comorbidities were also associated with a higher risk. In the multivariate analysis, a body mass index of more than 30 kg/m2, patients with cardiac risk factors, and fusions extending to the pelvis were independent risk factors.
  
  
  CONCLUSIONS
  Data from this large prospective multicenter study confirm that the incidence of early wound complications in pediatric spine surgery is low. Patients with a fusion extending to the pelvis, obese patients, and patients with significant cardiac conditions were independently associated with higher risk for this complication. These data should be useful for patients' counseling and for preoperative risk stratification. Interventions for minimizing wound complication risk may be most applicable to the high-risk groups identified here.
  
  
  METHODS
  2.
authors.affiliation: From the Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Martin
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Pugely
authors.forename: Yubo
authors.initials: Y
authors.lastname: Gao
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Ilgenfritz
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Weinstein
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000379:methods*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*; D013904:Thoracic Vertebrae / Q000601:surgery*; D013997:Time Factors; D014481:United States / Q000453:epidemiology