title: Does the Type of Metal Instrumentation Affect the Risk of Surgical Site Infection in Pediatric Scoliosis Surgery?
abstract: Retrospective cohort study.
  
  
  
  To determine the association of implant metal composition with the risk of surgical site infection (SSI) following pediatric spine surgery.
  
  
  
  SSI is a well-described complication following pediatric spine surgery. Many risk factors have been identified in the literature, but controversy remains regarding metal composition as a risk factor.
  
  
  
  This was a retrospective study of patients who underwent posterior spinal instrumentation procedures between January 1, 2006, and December 31, 2008, at three large children's hospitals for any etiology of scoliosis and had at least 1 year of postoperative follow-up. Procedures included posterior spinal fusion, growth-friendly instrumentation, and revision of spinal instrumentation. The Centers for Disease Control and Prevention definition of SSI was used. A chi-squared test was performed to determine the relationship between type of metal instrumentation and development of an SSI.
  
  
  
  The study included 874 patients who underwent 1,156 total procedures. Overall, 752 (65%) procedures used stainless steel instrumentation, 238 (21%) procedures used titanium instrumentation, and the remaining 166 (14%) procedures used cobalt chrome and titanium hybrid instrumentation. The overall risk of infection was 6.1% (70/1,156) per procedure, with 5.9% (44/752) for stainless steel, 6.7% (12/238) for titanium, and 6.0% (10/166) for cobalt chrome. The multiple regression analysis found no significant differences in the metal type used between patients with and without infection (p = .886) adjusting for etiology, instrumentation to pelvis, and type of procedures. When stratified based on etiology, the multiple regression analyses also found no significant difference in SSI between two metal type groups.
  
  
  
  This study found no difference in risk of infection with stainless steel, titanium, or cobalt chrome/titanium instrumentation and is adequately powered to detect a true difference in risk of SSI.
  
  
  
  Level II, prognostic.
authors.affiliation: Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA. Electronic address: Mlw2147@columbia.edu.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Wright
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
authors.affiliation: Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Matsumoto
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Regina P
authors.initials: RP
authors.lastname: Woon
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Trocle
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Flynn
authors.affiliation: Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Vitale
mesh_terms: D002648:Child; D006801:Humans; D012189:Retrospective Studies; D012306:Risk; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D013131:Spine; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014481:United States
keywords: Infection; Metal; Scoliosis