title: Variability of Surgical Site Infection With VEPTR at Eight Centers: A Retrospective Cohort Analysis.
abstract: Retrospective review.
  
  
  
  To describe clinical characteristics and infection rates in modern vertical expandable prosthetic titanium rib (VEPTR) surgery.
  
  
  
  Prior studies have demonstrated infection rates from 10% to 30% with VEPTR surgery.
  
  
  
  A retrospective query was done on an institutional review board-approved, multicenter prospectively collected database for patients implanted with VEPTR from 2007 to 2013 at eight sites. This identified 213 patients with appropriate data for analysis. Average follow-up was 4.1 years (range 1.7-6.3). Data collected included a Classification of Early-Onset Scoliosis (C-EOS) diagnosis, American Society of Anesthesiologists Physical Status (ASA-PS), major Cobb angle, construct type, clinical symptoms, and microbiology. The distribution of infection rates across all the study sites was compared. The exact p value was estimated by Monte Carlo simulation.
  
  
  
  Overall, 18% (38/213) of patients implanted with VEPTR developed infection requiring operative debridement. There were significantly different infection rates among the sites, ranging from 2.9% to 42.9% (p = .029). The average time to infection was 70 days (range 8-236) after the infecting procedure. The majority of infections were due to gram-positive bacteria (80%, 44/55), the most prevalent being methicillin-sensitive Staphylococcus aureus (45%, 25/55). There were 20 patients (53%, 20/38) with either partial or complete implant removal to resolve infection; however, only 3 of 38 (8%) of these resulted in abandonment of VEPTR treatment. There was no difference in infection rate across the primary C-EOS diagnosis categories (p = .21) or based on ASA score (p = .53). After controlling for study site, the odds ratio of an infection following an implant procedure versus an expansion was 2.8 (p = .002). There was no difference in the odds ratio of an infection between the other procedure types (implant, expansion, exchange/revision).
  
  
  
  There were significant differences in infection rates between sites. The variability in infection rate indicates a need for guided efforts to standardize best practices for infection control in VEPTR surgery.
  
  
  
  III, therapeutic study.
authors.affiliation: University of Colorado, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA. Electronic address: sumeet.garg@childrenscolorado.org.
authors.forename: Sumeet
authors.initials: S
authors.lastname: Garg
authors.affiliation: University of Colorado, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA.
authors.forename: Micaela
authors.initials: M
authors.lastname: Cyr
authors.affiliation: Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA.
authors.forename: Tricia
authors.initials: T
authors.lastname: St Hilaire
authors.affiliation: Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Flynn
authors.affiliation: University of Colorado, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Carry
authors.affiliation: Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA; Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Glotzbecker
authors.affiliation: Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA; Primary Children's Medical Center, 100 North Mario Capecchi Drive, Salt Lake City, UT 84113, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Smith
authors.affiliation: Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA; University of Tennessee, Campbell Clinic, 1211 Union Avenue, Memphis, TN 38104, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Sawyer
authors.affiliation: Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA; Shriners Hospital for Children, 3551 North Broad Street, Philadelphia, PA 19140, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Pahys
authors.affiliation: Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA; Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Luhmann
authors.affiliation: Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA; The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Flynn
authors.affiliation: Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA; IWK Health Centre, 5980 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada.
authors.forename: Ron
authors.initials: R
authors.lastname: El-Hawary
authors.affiliation: Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA; Children's Hospital of New York, 3959 Broadway, New York, NY 10032, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Vitale
mesh_terms: D006801:Humans; D012189:Retrospective Studies; D012272:Ribs; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D013530:Surgical Wound Infection; D014025:Titanium
chemical_list: D014025:Titanium
keywords: Early-onset scoliosis; Infection; VEPTR