Deep Surgical Site Infections Following Pediatric Cervical Spine Surgery.
BACKGROUND
This is the first reported series looking specifically at factors associated with deep surgical site infections (SSI) following pediatric cervical spine surgery.


OBJECTIVE
To identify risk factors present in pediatric patients who are at risk for SSI following cervical spine surgery.


METHODS
Level of evidence: level IV-retrospective case series.


BACKGROUND
To date there are no studies regarding SSI in pediatric cervical spine surgery and thus no benchmark data or risk factors have been identified.


METHODS
Patients with acute deep SSIs occurring within 90 days of the index operation were identified. Patient and surgical characteristics were analyzed for possible predictors of SSI outcome using penalized likelihood logistic regression analysis. Characteristics analyzed included: age, diagnosis, comorbidity, levels fused, approach, implants used, allograft, halo, body mass index, revision, antibiotic dosing, and occipital plating.


RESULTS
A total of 112 patients were included in the study at a mean age of 12.5 years (2 to 18 y). Comorbidities were present in 51 (46%) patients, 15 patients had a documented connective tissue disorder (CTD). The mean number of levels fused was 3.7 (2 to 7) and mean number of screws was 4.4 (2 to 11). Allograft was used alone in 48 patients, occipital plating in 28 patients, and a halo in 39 patients. Deep SSI occurred in 3 patients: two of which had a CTD (1 Trisomy 21, 1 Ehlers-Danlos) and 1 patient with postradiation cervical kyphosis. All were gram-positive infections requiring return to operating room with prolonged IV antibiotics. All patients recovered and fused with spinal implant retention. The incidence of deep SSI was 2.7%. It was determined that a CTD was the only significant predictor of SSI. Subjects with a CTD had 12 times the odds of SSI [odds ratio=12 (1.5, 137.0); P=0.02].


CONCLUSIONS
In our series of pediatric patients the incidence of a deep SSI was 2.7%. The only predictor of SSI was the presence of a CTD.
*Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY †Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.
David A
DA
Porter
Michael P
MP
Glotzbecker
M
M
Timothy Hresko
Daniel J
DJ
Hedequist
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003240:Connective Tissue Diseases / Q000150:complications; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011184:Postoperative Period; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control
D000900:Anti-Bacterial Agents