title: Risk factors for surgical site infections after pediatric spine operations.
abstract: METHODS
  Matched case-control study.
  
  
  OBJECTIVE
  To identify modifiable risk factors for surgical site infections (SSIs) after pediatric spinal fusion.
  
  
  BACKGROUND
  The number of SSIs after pediatric spinal fusions increased.
  
  
  METHODS
  Between July 2001 and July 2010, 22 of 598 pediatric patients who underwent spinal fusion at a university hospital acquired SSIs. Each patient with an SSI was matched with 2 controls by procedure date. Bivariable and multivariable analyses were used to identify risk factors for SSIs and outcomes of SSIs.
  
  
  RESULTS
  Gram-negative organisms caused more than 50% of the SSIs. By multivariable analysis, neuromuscular scoliosis (odds ratio [OR] = 20.8; 95% confidence interval [CI], 3.1-889.5; P < 0.0001) and weight-for-age at the 95th percentile or higher (OR = 8.6; 95% CI, 1.2-124.9; P = 0.02) were preoperative factors associated with SSIs. Blood loss (OR = 1.0; 95% CI, 1.0-1.0; P = 0.039) and allografts and allografts in combination with other grafts were operative risk factors for SSIs. The final overall risk model for SSIs was weight-for-age at the 95th percentile or higher (OR = 4.0; 95% CI, 1.4-∞; P = 0.037), American Society of Anesthesiologists score 3 or more (OR = 3.8; 95% CI, 1.6-∞; P = 0.01), and prolonged operation duration (OR = 1.0/min increase; 95% CI, 1.0-1.0; P = 0.004). SSIs were associated with 2.8 days of additional postoperative length of stay (P = 0.02). Neuromuscular scoliosis was the only factor significantly associated with hospital readmission (OR = 23.6; 95% CI, 3.8-147.3; P = 0.0007).
  
  
  CONCLUSIONS
  Our results suggest that pediatric patients undergoing spinal fusion might benefit from antimicrobial prophylaxis that covers gram-negative organisms. Surgical duration, graft implantation, and blood loss are potentially modifiable operative risk factors. Neuromuscular scoliosis, high weight-for-age, and American Society of Anesthesiologists scores 3 or more may help surgical teams identify patients at high risk for SSI.
authors.affiliation: *Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore †Clinical Quality, Safety, and Process Improvement, University of Iowa Hospitals and Clinics, Iowa City ‡Department of Epidemiology, University of Iowa College of Public Health, Iowa City; and Departments of §Internal Medicine ¶Pediatrics, and ‖Orthopedics, University of Iowa Carver College of Medicine, Iowa City.
authors.forename: Lindsay D
authors.initials: LD
authors.lastname: Croft
authors.forename: Jean M
authors.initials: JM
authors.lastname: Pottinger
authors.forename: Hsiu-Yin
authors.initials: HY
authors.lastname: Chiang
authors.forename: Christine S
authors.initials: CS
authors.lastname: Ziebold
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Weinstein
authors.forename: Loreen A
authors.initials: LA
authors.lastname: Herwaldt
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D013131:Spine / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology*