Surgical Site Infection After Primary Spinal Fusion Surgery for Adolescent Idiopathic Scoliosis: An Analysis of Risk Factors From a Nationwide Insurance Database

• Published in: Spine (Philadelphia, Pa. 1976) Vol. 48; no. 8; pp. E101 - E106
• Main Authors: Rudic, Theodore N., Althoff, Alyssa D., Kamalapathy, Pramod, Bachmann, Keith R.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 15-04-2023
• Subjects: Adolescent; Child; Female; Humans; Male; Obesity - complications; Retrospective Studies; Risk Factors; Scoliosis - epidemiology; Spinal Fusion - adverse effects; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0000000000004591

Retrospective review.
The purpose of this study was to quantify the incidence and factors associated with surgical site infection (SSI) in pediatric patients undergoing spinal fusion for adolescent idiopathic scoliosis (AIS).
Infection is a morbid complication after spinal fusion. The incidence of SSI after pediatric spinal fusion is likely underestimated; the use of a national database allows for a comprehensive assessment of this rare outcome.
The PearlDiver Database was used to identify AIS patients who underwent primary instrumented spinal fusion between 2010 and 2019 and relevant patient records were queried to identify infections within 7, 30, and 90 postoperative days. Patients with nonidiopathic scoliosis were excluded. Logistic regression was used to evaluate risk factors associated with postoperative infection.
Out of 9801 patients who underwent primary fusion for AIS, 44 patients (0.4%) developed an infection within 7 postoperative days. The 30 days and 90 days incidences were 1.9% and 2.7%, respectively. Within 90 days, 154 (57.7%) of the patients with infection had undergone reoperation, of whom 72 underwent multiple reoperations. Obesity and male sex ( P < 0.05) were significantly associated with postoperative infection. The length of fusion was not a significant factor in the development of SSI ( P > 0.05). Eleven patients underwent an operation requiring hardware removal within 90 days. There were no significant factors associated with those undergoing hardware removal compared with those undergoing surgical debridement.
The study identified a 2.7% 90 days incidence of SSI after posterior spinal fusion for AIS, with 57.7% of all infections requiring a return to the operating room. Preoperative patient-related characteristics associated with increased risk of postoperative SSI were male sex and obesity. The current study can be used to provide preoperative counseling regarding the risk of this postoperative complication.
Level III.