title: Risk factors for delayed infections after spinal fusion and instrumentation in patients with scoliosis. Clinical article.
abstract: OBJECTIVE
  There are limited published data about the risk factors for the development of delayed infections after spinal fusion and instrumentation in the population with scoliosis. The objective of this study was to evaluate the predictive factors of development of delayed infections in patients with scoliosis who underwent surgical treatment.
  
  
  METHODS
  A total of 17 patients with scoliosis and delayed infections were identified from 3463 patients with scoliosis who received surgical treatment. The control group was composed of 85 patients with scoliosis without infections, matched for sex, age, approximate date of surgery, and diagnosis. These 2 groups were compared for demographic distribution and clinical data to investigate the predictive factors of delayed infections.
  
  
  RESULTS
  The overall incidence rate of delayed infections was 0.49%. The variables of age, body mass index, and number of levels fused were similar between the 2 groups. The average primary curve magnitude for the delayed infection and control (uninfected) groups was 80.4° ± 27.0° (range 47°-135°) and 66.3° ± 11.6° (range 42°-95°), respectively (p = 0.001). Operation time in the group with delayed infections was 384.7 ± 115.9 minutes versus 254.4 ± 79.2 minutes in the control group (p = 0.000), and estimated blood loss was 1342.2 ± 707.2 ml versus 833.9 ± 235.6 ml (p = 0.000) in these 2 groups, respectively. The perioperative mean red blood cell transfusion requirement in the delayed infection group was significantly higher than that found in patients without infections (2.8 ± 2.3 units/patient versus 1.1 ± 1.6 units/patient, respectively; p = 0.000). Logistic regression analysis showed that operation time and allogenic blood transfusion were the 2 independent predictors of delayed infections (odds ratio [OR] 1.021, 95% confidence interval [CI] 1.010-1.033, and OR 1.546, 95% CI 1.048-2.278, respectively).
  
  
  CONCLUSIONS
  The occurrence of a delayed infection in patients with scoliosis who undergo surgical treatment is most likely multifactorial and is related to surgical time and the use of allogenic blood transfusion.
authors.affiliation: Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Beijing; and.
authors.forename: Jianxiong
authors.initials: J
authors.lastname: Shen
authors.forename: Jinqian
authors.initials: J
authors.lastname: Liang
authors.forename: Haiquan
authors.initials: H
authors.lastname: Yu
authors.forename: Guixing
authors.initials: G
authors.lastname: Qiu
authors.forename: Xuhong
authors.initials: X
authors.lastname: Xue
authors.forename: Zheng
authors.initials: Z
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002648:Child; D002681:China / Q000453:epidemiology; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome
keywords: BMI = body mass index; CI = confidence interval; EBL = estimated blood loss; OR = odds ratio; delayed infection; risk factor; scoliosis; spinal fusion