Management of Spinal Implants in Acute Pediatric Surgical Site Infections: A Multicenter Study
Study Design A retrospective review of patients who underwent posterior spinal fusion (PSF) and returned within 90 days with an acute infection. Objectives The study motive is to identify and understand the risk factors associated with failure of retaining spinal implants and failure to treat acute...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Glotzbecker, Michael P. [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2016 |
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| Schlagwörter: |
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| Anmerkung: |
© Scoliosis Research Society 2016 |
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| Übergeordnetes Werk: |
Enthalten in: Spine deformity - Amsterdam [u.a.] : Elsevier, 2013, 4(2016), 4 vom: Juli, Seite 277-282 |
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| Übergeordnetes Werk: |
volume:4 ; year:2016 ; number:4 ; month:07 ; pages:277-282 |
| Links: |
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| DOI / URN: |
10.1016/j.jspd.2016.02.001 |
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SPR038869632 |
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| 520 | |a Study Design A retrospective review of patients who underwent posterior spinal fusion (PSF) and returned within 90 days with an acute infection. Objectives The study motive is to identify and understand the risk factors associated with failure of retaining spinal implants and failure to treat acute infection. Background The natural history of early surgical site infection (SSI) (less than 3 months) after PSF is not known and removing the implants early after PSF risks pseudarthrosis and deformity progression. Methods Patients ranging from 1999 to 2011 with surgical site infections (SSIs) who required irrigation and debridement within 3 months of PSF were identified from 4 institutions. Univariable and multivariable regression analysis were used to identify risk factors associated with failure of acute infection treatment. Results Eighty-two patients (59 female, 23 male) with a mean age of 13.6 years were identified. Median follow-up after initial surgery was 33 months (range: 12–112 months). Sixty-two (76%) were treated successfully with acute treatment and did not return with recurrent infection (cleared infection, group C); 20 (24%) returned later with chronic infection (recurrent infection, group R). Multivariable analysis indicated that patients with stainless steel implants (OR = 6.4, 95% CI = 1.7–32.1; p =.009) and older subjects (OR = 1.3, 95% CI = 1.0–1.6; p =.03) were more likely to present with recurrent infection. There was no difference between the groups with regard to the initial time of presentation post fusion, proportion of non-idiopathic diagnosis, rate of positive cultures, culture species, presence of fusion to pelvis, and time on antibiotic treatment. Conclusions Seventy-six percent of patients presenting with an SSI less than 3 months after PSF did not require implant removal to clear their infection. Early postoperative SSIs can be treated with retention or implant exchange. Older patients and patients with stainless steel instrumentation are more likely to present with a late recurrent infection compared to other metals. Level of Evidence Level III. | ||
| 650 | 4 | |a Posterior spine fusion |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Acute infection |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Spine instrumentation |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Surgical site infection |7 (dpeaa)DE-He213 | |
| 700 | 1 | |a Gomez, Jaime A. |4 aut | |
| 700 | 1 | |a Miller, Patricia E. |4 aut | |
| 700 | 1 | |a Troy, Michael J. |4 aut | |
| 700 | 1 | |a Skaggs, David L. |4 aut | |
| 700 | 1 | |a Vitale, Michael G. |4 aut | |
| 700 | 1 | |a Flynn, John M. |4 aut | |
| 700 | 1 | |a Barrett, Kody K. |4 aut | |
| 700 | 1 | |a Pace, Gregory I. |4 aut | |
| 700 | 1 | |a Atuahene, Brittany N. |4 aut | |
| 700 | 1 | |a Hedequist, Daniel J. |4 aut | |
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10.1016/j.jspd.2016.02.001 doi (DE-627)SPR038869632 (SPR)j.jspd.2016.02.001-e DE-627 ger DE-627 rakwb eng Glotzbecker, Michael P. verfasserin aut Management of Spinal Implants in Acute Pediatric Surgical Site Infections: A Multicenter Study 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Scoliosis Research Society 2016 Study Design A retrospective review of patients who underwent posterior spinal fusion (PSF) and returned within 90 days with an acute infection. Objectives The study motive is to identify and understand the risk factors associated with failure of retaining spinal implants and failure to treat acute infection. Background The natural history of early surgical site infection (SSI) (less than 3 months) after PSF is not known and removing the implants early after PSF risks pseudarthrosis and deformity progression. Methods Patients ranging from 1999 to 2011 with surgical site infections (SSIs) who required irrigation and debridement within 3 months of PSF were identified from 4 institutions. Univariable and multivariable regression analysis were used to identify risk factors associated with failure of acute infection treatment. Results Eighty-two patients (59 female, 23 male) with a mean age of 13.6 years were identified. Median follow-up after initial surgery was 33 months (range: 12–112 months). Sixty-two (76%) were treated successfully with acute treatment and did not return with recurrent infection (cleared infection, group C); 20 (24%) returned later with chronic infection (recurrent infection, group R). Multivariable analysis indicated that patients with stainless steel implants (OR = 6.4, 95% CI = 1.7–32.1; p =.009) and older subjects (OR = 1.3, 95% CI = 1.0–1.6; p =.03) were more likely to present with recurrent infection. There was no difference between the groups with regard to the initial time of presentation post fusion, proportion of non-idiopathic diagnosis, rate of positive cultures, culture species, presence of fusion to pelvis, and time on antibiotic treatment. Conclusions Seventy-six percent of patients presenting with an SSI less than 3 months after PSF did not require implant removal to clear their infection. Early postoperative SSIs can be treated with retention or implant exchange. Older patients and patients with stainless steel instrumentation are more likely to present with a late recurrent infection compared to other metals. Level of Evidence Level III. Posterior spine fusion (dpeaa)DE-He213 Acute infection (dpeaa)DE-He213 Spine instrumentation (dpeaa)DE-He213 Surgical site infection (dpeaa)DE-He213 Gomez, Jaime A. aut Miller, Patricia E. aut Troy, Michael J. aut Skaggs, David L. aut Vitale, Michael G. aut Flynn, John M. aut Barrett, Kody K. aut Pace, Gregory I. aut Atuahene, Brittany N. aut Hedequist, Daniel J. aut Enthalten in Spine deformity Amsterdam [u.a.] : Elsevier, 2013 4(2016), 4 vom: Juli, Seite 277-282 (DE-627)747142815 (DE-600)2717704-X 2212-1358 nnns volume:4 year:2016 number:4 month:07 pages:277-282 https://dx.doi.org/10.1016/j.jspd.2016.02.001 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_647 GBV_ILN_702 GBV_ILN_2004 GBV_ILN_2190 GBV_ILN_2336 AR 4 2016 4 07 277-282 |
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10.1016/j.jspd.2016.02.001 doi (DE-627)SPR038869632 (SPR)j.jspd.2016.02.001-e DE-627 ger DE-627 rakwb eng Glotzbecker, Michael P. verfasserin aut Management of Spinal Implants in Acute Pediatric Surgical Site Infections: A Multicenter Study 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Scoliosis Research Society 2016 Study Design A retrospective review of patients who underwent posterior spinal fusion (PSF) and returned within 90 days with an acute infection. Objectives The study motive is to identify and understand the risk factors associated with failure of retaining spinal implants and failure to treat acute infection. Background The natural history of early surgical site infection (SSI) (less than 3 months) after PSF is not known and removing the implants early after PSF risks pseudarthrosis and deformity progression. Methods Patients ranging from 1999 to 2011 with surgical site infections (SSIs) who required irrigation and debridement within 3 months of PSF were identified from 4 institutions. Univariable and multivariable regression analysis were used to identify risk factors associated with failure of acute infection treatment. Results Eighty-two patients (59 female, 23 male) with a mean age of 13.6 years were identified. Median follow-up after initial surgery was 33 months (range: 12–112 months). Sixty-two (76%) were treated successfully with acute treatment and did not return with recurrent infection (cleared infection, group C); 20 (24%) returned later with chronic infection (recurrent infection, group R). Multivariable analysis indicated that patients with stainless steel implants (OR = 6.4, 95% CI = 1.7–32.1; p =.009) and older subjects (OR = 1.3, 95% CI = 1.0–1.6; p =.03) were more likely to present with recurrent infection. There was no difference between the groups with regard to the initial time of presentation post fusion, proportion of non-idiopathic diagnosis, rate of positive cultures, culture species, presence of fusion to pelvis, and time on antibiotic treatment. Conclusions Seventy-six percent of patients presenting with an SSI less than 3 months after PSF did not require implant removal to clear their infection. Early postoperative SSIs can be treated with retention or implant exchange. Older patients and patients with stainless steel instrumentation are more likely to present with a late recurrent infection compared to other metals. Level of Evidence Level III. Posterior spine fusion (dpeaa)DE-He213 Acute infection (dpeaa)DE-He213 Spine instrumentation (dpeaa)DE-He213 Surgical site infection (dpeaa)DE-He213 Gomez, Jaime A. aut Miller, Patricia E. aut Troy, Michael J. aut Skaggs, David L. aut Vitale, Michael G. aut Flynn, John M. aut Barrett, Kody K. aut Pace, Gregory I. aut Atuahene, Brittany N. aut Hedequist, Daniel J. aut Enthalten in Spine deformity Amsterdam [u.a.] : Elsevier, 2013 4(2016), 4 vom: Juli, Seite 277-282 (DE-627)747142815 (DE-600)2717704-X 2212-1358 nnns volume:4 year:2016 number:4 month:07 pages:277-282 https://dx.doi.org/10.1016/j.jspd.2016.02.001 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_647 GBV_ILN_702 GBV_ILN_2004 GBV_ILN_2190 GBV_ILN_2336 AR 4 2016 4 07 277-282 |
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10.1016/j.jspd.2016.02.001 doi (DE-627)SPR038869632 (SPR)j.jspd.2016.02.001-e DE-627 ger DE-627 rakwb eng Glotzbecker, Michael P. verfasserin aut Management of Spinal Implants in Acute Pediatric Surgical Site Infections: A Multicenter Study 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Scoliosis Research Society 2016 Study Design A retrospective review of patients who underwent posterior spinal fusion (PSF) and returned within 90 days with an acute infection. Objectives The study motive is to identify and understand the risk factors associated with failure of retaining spinal implants and failure to treat acute infection. Background The natural history of early surgical site infection (SSI) (less than 3 months) after PSF is not known and removing the implants early after PSF risks pseudarthrosis and deformity progression. Methods Patients ranging from 1999 to 2011 with surgical site infections (SSIs) who required irrigation and debridement within 3 months of PSF were identified from 4 institutions. Univariable and multivariable regression analysis were used to identify risk factors associated with failure of acute infection treatment. Results Eighty-two patients (59 female, 23 male) with a mean age of 13.6 years were identified. Median follow-up after initial surgery was 33 months (range: 12–112 months). Sixty-two (76%) were treated successfully with acute treatment and did not return with recurrent infection (cleared infection, group C); 20 (24%) returned later with chronic infection (recurrent infection, group R). Multivariable analysis indicated that patients with stainless steel implants (OR = 6.4, 95% CI = 1.7–32.1; p =.009) and older subjects (OR = 1.3, 95% CI = 1.0–1.6; p =.03) were more likely to present with recurrent infection. There was no difference between the groups with regard to the initial time of presentation post fusion, proportion of non-idiopathic diagnosis, rate of positive cultures, culture species, presence of fusion to pelvis, and time on antibiotic treatment. Conclusions Seventy-six percent of patients presenting with an SSI less than 3 months after PSF did not require implant removal to clear their infection. Early postoperative SSIs can be treated with retention or implant exchange. Older patients and patients with stainless steel instrumentation are more likely to present with a late recurrent infection compared to other metals. Level of Evidence Level III. Posterior spine fusion (dpeaa)DE-He213 Acute infection (dpeaa)DE-He213 Spine instrumentation (dpeaa)DE-He213 Surgical site infection (dpeaa)DE-He213 Gomez, Jaime A. aut Miller, Patricia E. aut Troy, Michael J. aut Skaggs, David L. aut Vitale, Michael G. aut Flynn, John M. aut Barrett, Kody K. aut Pace, Gregory I. aut Atuahene, Brittany N. aut Hedequist, Daniel J. aut Enthalten in Spine deformity Amsterdam [u.a.] : Elsevier, 2013 4(2016), 4 vom: Juli, Seite 277-282 (DE-627)747142815 (DE-600)2717704-X 2212-1358 nnns volume:4 year:2016 number:4 month:07 pages:277-282 https://dx.doi.org/10.1016/j.jspd.2016.02.001 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_647 GBV_ILN_702 GBV_ILN_2004 GBV_ILN_2190 GBV_ILN_2336 AR 4 2016 4 07 277-282 |
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10.1016/j.jspd.2016.02.001 doi (DE-627)SPR038869632 (SPR)j.jspd.2016.02.001-e DE-627 ger DE-627 rakwb eng Glotzbecker, Michael P. verfasserin aut Management of Spinal Implants in Acute Pediatric Surgical Site Infections: A Multicenter Study 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Scoliosis Research Society 2016 Study Design A retrospective review of patients who underwent posterior spinal fusion (PSF) and returned within 90 days with an acute infection. Objectives The study motive is to identify and understand the risk factors associated with failure of retaining spinal implants and failure to treat acute infection. Background The natural history of early surgical site infection (SSI) (less than 3 months) after PSF is not known and removing the implants early after PSF risks pseudarthrosis and deformity progression. Methods Patients ranging from 1999 to 2011 with surgical site infections (SSIs) who required irrigation and debridement within 3 months of PSF were identified from 4 institutions. Univariable and multivariable regression analysis were used to identify risk factors associated with failure of acute infection treatment. Results Eighty-two patients (59 female, 23 male) with a mean age of 13.6 years were identified. Median follow-up after initial surgery was 33 months (range: 12–112 months). Sixty-two (76%) were treated successfully with acute treatment and did not return with recurrent infection (cleared infection, group C); 20 (24%) returned later with chronic infection (recurrent infection, group R). Multivariable analysis indicated that patients with stainless steel implants (OR = 6.4, 95% CI = 1.7–32.1; p =.009) and older subjects (OR = 1.3, 95% CI = 1.0–1.6; p =.03) were more likely to present with recurrent infection. There was no difference between the groups with regard to the initial time of presentation post fusion, proportion of non-idiopathic diagnosis, rate of positive cultures, culture species, presence of fusion to pelvis, and time on antibiotic treatment. Conclusions Seventy-six percent of patients presenting with an SSI less than 3 months after PSF did not require implant removal to clear their infection. Early postoperative SSIs can be treated with retention or implant exchange. Older patients and patients with stainless steel instrumentation are more likely to present with a late recurrent infection compared to other metals. Level of Evidence Level III. Posterior spine fusion (dpeaa)DE-He213 Acute infection (dpeaa)DE-He213 Spine instrumentation (dpeaa)DE-He213 Surgical site infection (dpeaa)DE-He213 Gomez, Jaime A. aut Miller, Patricia E. aut Troy, Michael J. aut Skaggs, David L. aut Vitale, Michael G. aut Flynn, John M. aut Barrett, Kody K. aut Pace, Gregory I. aut Atuahene, Brittany N. aut Hedequist, Daniel J. aut Enthalten in Spine deformity Amsterdam [u.a.] : Elsevier, 2013 4(2016), 4 vom: Juli, Seite 277-282 (DE-627)747142815 (DE-600)2717704-X 2212-1358 nnns volume:4 year:2016 number:4 month:07 pages:277-282 https://dx.doi.org/10.1016/j.jspd.2016.02.001 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_647 GBV_ILN_702 GBV_ILN_2004 GBV_ILN_2190 GBV_ILN_2336 AR 4 2016 4 07 277-282 |
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10.1016/j.jspd.2016.02.001 doi (DE-627)SPR038869632 (SPR)j.jspd.2016.02.001-e DE-627 ger DE-627 rakwb eng Glotzbecker, Michael P. verfasserin aut Management of Spinal Implants in Acute Pediatric Surgical Site Infections: A Multicenter Study 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Scoliosis Research Society 2016 Study Design A retrospective review of patients who underwent posterior spinal fusion (PSF) and returned within 90 days with an acute infection. Objectives The study motive is to identify and understand the risk factors associated with failure of retaining spinal implants and failure to treat acute infection. Background The natural history of early surgical site infection (SSI) (less than 3 months) after PSF is not known and removing the implants early after PSF risks pseudarthrosis and deformity progression. Methods Patients ranging from 1999 to 2011 with surgical site infections (SSIs) who required irrigation and debridement within 3 months of PSF were identified from 4 institutions. Univariable and multivariable regression analysis were used to identify risk factors associated with failure of acute infection treatment. Results Eighty-two patients (59 female, 23 male) with a mean age of 13.6 years were identified. Median follow-up after initial surgery was 33 months (range: 12–112 months). Sixty-two (76%) were treated successfully with acute treatment and did not return with recurrent infection (cleared infection, group C); 20 (24%) returned later with chronic infection (recurrent infection, group R). Multivariable analysis indicated that patients with stainless steel implants (OR = 6.4, 95% CI = 1.7–32.1; p =.009) and older subjects (OR = 1.3, 95% CI = 1.0–1.6; p =.03) were more likely to present with recurrent infection. There was no difference between the groups with regard to the initial time of presentation post fusion, proportion of non-idiopathic diagnosis, rate of positive cultures, culture species, presence of fusion to pelvis, and time on antibiotic treatment. Conclusions Seventy-six percent of patients presenting with an SSI less than 3 months after PSF did not require implant removal to clear their infection. Early postoperative SSIs can be treated with retention or implant exchange. Older patients and patients with stainless steel instrumentation are more likely to present with a late recurrent infection compared to other metals. Level of Evidence Level III. Posterior spine fusion (dpeaa)DE-He213 Acute infection (dpeaa)DE-He213 Spine instrumentation (dpeaa)DE-He213 Surgical site infection (dpeaa)DE-He213 Gomez, Jaime A. aut Miller, Patricia E. aut Troy, Michael J. aut Skaggs, David L. aut Vitale, Michael G. aut Flynn, John M. aut Barrett, Kody K. aut Pace, Gregory I. aut Atuahene, Brittany N. aut Hedequist, Daniel J. aut Enthalten in Spine deformity Amsterdam [u.a.] : Elsevier, 2013 4(2016), 4 vom: Juli, Seite 277-282 (DE-627)747142815 (DE-600)2717704-X 2212-1358 nnns volume:4 year:2016 number:4 month:07 pages:277-282 https://dx.doi.org/10.1016/j.jspd.2016.02.001 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_647 GBV_ILN_702 GBV_ILN_2004 GBV_ILN_2190 GBV_ILN_2336 AR 4 2016 4 07 277-282 |
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Objectives The study motive is to identify and understand the risk factors associated with failure of retaining spinal implants and failure to treat acute infection. Background The natural history of early surgical site infection (SSI) (less than 3 months) after PSF is not known and removing the implants early after PSF risks pseudarthrosis and deformity progression. Methods Patients ranging from 1999 to 2011 with surgical site infections (SSIs) who required irrigation and debridement within 3 months of PSF were identified from 4 institutions. Univariable and multivariable regression analysis were used to identify risk factors associated with failure of acute infection treatment. Results Eighty-two patients (59 female, 23 male) with a mean age of 13.6 years were identified. Median follow-up after initial surgery was 33 months (range: 12–112 months). Sixty-two (76%) were treated successfully with acute treatment and did not return with recurrent infection (cleared infection, group C); 20 (24%) returned later with chronic infection (recurrent infection, group R). Multivariable analysis indicated that patients with stainless steel implants (OR = 6.4, 95% CI = 1.7–32.1; p =.009) and older subjects (OR = 1.3, 95% CI = 1.0–1.6; p =.03) were more likely to present with recurrent infection. There was no difference between the groups with regard to the initial time of presentation post fusion, proportion of non-idiopathic diagnosis, rate of positive cultures, culture species, presence of fusion to pelvis, and time on antibiotic treatment. Conclusions Seventy-six percent of patients presenting with an SSI less than 3 months after PSF did not require implant removal to clear their infection. Early postoperative SSIs can be treated with retention or implant exchange. Older patients and patients with stainless steel instrumentation are more likely to present with a late recurrent infection compared to other metals. 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Management of Spinal Implants in Acute Pediatric Surgical Site Infections: A Multicenter Study Posterior spine fusion (dpeaa)DE-He213 Acute infection (dpeaa)DE-He213 Spine instrumentation (dpeaa)DE-He213 Surgical site infection (dpeaa)DE-He213 |
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Glotzbecker, Michael P. Gomez, Jaime A. Miller, Patricia E. Troy, Michael J. Skaggs, David L. Vitale, Michael G. Flynn, John M. Barrett, Kody K. Pace, Gregory I. Atuahene, Brittany N. Hedequist, Daniel J. |
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management of spinal implants in acute pediatric surgical site infections: a multicenter study |
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Management of Spinal Implants in Acute Pediatric Surgical Site Infections: A Multicenter Study |
| abstract |
Study Design A retrospective review of patients who underwent posterior spinal fusion (PSF) and returned within 90 days with an acute infection. Objectives The study motive is to identify and understand the risk factors associated with failure of retaining spinal implants and failure to treat acute infection. Background The natural history of early surgical site infection (SSI) (less than 3 months) after PSF is not known and removing the implants early after PSF risks pseudarthrosis and deformity progression. Methods Patients ranging from 1999 to 2011 with surgical site infections (SSIs) who required irrigation and debridement within 3 months of PSF were identified from 4 institutions. Univariable and multivariable regression analysis were used to identify risk factors associated with failure of acute infection treatment. Results Eighty-two patients (59 female, 23 male) with a mean age of 13.6 years were identified. Median follow-up after initial surgery was 33 months (range: 12–112 months). Sixty-two (76%) were treated successfully with acute treatment and did not return with recurrent infection (cleared infection, group C); 20 (24%) returned later with chronic infection (recurrent infection, group R). Multivariable analysis indicated that patients with stainless steel implants (OR = 6.4, 95% CI = 1.7–32.1; p =.009) and older subjects (OR = 1.3, 95% CI = 1.0–1.6; p =.03) were more likely to present with recurrent infection. There was no difference between the groups with regard to the initial time of presentation post fusion, proportion of non-idiopathic diagnosis, rate of positive cultures, culture species, presence of fusion to pelvis, and time on antibiotic treatment. Conclusions Seventy-six percent of patients presenting with an SSI less than 3 months after PSF did not require implant removal to clear their infection. Early postoperative SSIs can be treated with retention or implant exchange. Older patients and patients with stainless steel instrumentation are more likely to present with a late recurrent infection compared to other metals. Level of Evidence Level III. © Scoliosis Research Society 2016 |
| abstractGer |
Study Design A retrospective review of patients who underwent posterior spinal fusion (PSF) and returned within 90 days with an acute infection. Objectives The study motive is to identify and understand the risk factors associated with failure of retaining spinal implants and failure to treat acute infection. Background The natural history of early surgical site infection (SSI) (less than 3 months) after PSF is not known and removing the implants early after PSF risks pseudarthrosis and deformity progression. Methods Patients ranging from 1999 to 2011 with surgical site infections (SSIs) who required irrigation and debridement within 3 months of PSF were identified from 4 institutions. Univariable and multivariable regression analysis were used to identify risk factors associated with failure of acute infection treatment. Results Eighty-two patients (59 female, 23 male) with a mean age of 13.6 years were identified. Median follow-up after initial surgery was 33 months (range: 12–112 months). Sixty-two (76%) were treated successfully with acute treatment and did not return with recurrent infection (cleared infection, group C); 20 (24%) returned later with chronic infection (recurrent infection, group R). Multivariable analysis indicated that patients with stainless steel implants (OR = 6.4, 95% CI = 1.7–32.1; p =.009) and older subjects (OR = 1.3, 95% CI = 1.0–1.6; p =.03) were more likely to present with recurrent infection. There was no difference between the groups with regard to the initial time of presentation post fusion, proportion of non-idiopathic diagnosis, rate of positive cultures, culture species, presence of fusion to pelvis, and time on antibiotic treatment. Conclusions Seventy-six percent of patients presenting with an SSI less than 3 months after PSF did not require implant removal to clear their infection. Early postoperative SSIs can be treated with retention or implant exchange. Older patients and patients with stainless steel instrumentation are more likely to present with a late recurrent infection compared to other metals. Level of Evidence Level III. © Scoliosis Research Society 2016 |
| abstract_unstemmed |
Study Design A retrospective review of patients who underwent posterior spinal fusion (PSF) and returned within 90 days with an acute infection. Objectives The study motive is to identify and understand the risk factors associated with failure of retaining spinal implants and failure to treat acute infection. Background The natural history of early surgical site infection (SSI) (less than 3 months) after PSF is not known and removing the implants early after PSF risks pseudarthrosis and deformity progression. Methods Patients ranging from 1999 to 2011 with surgical site infections (SSIs) who required irrigation and debridement within 3 months of PSF were identified from 4 institutions. Univariable and multivariable regression analysis were used to identify risk factors associated with failure of acute infection treatment. Results Eighty-two patients (59 female, 23 male) with a mean age of 13.6 years were identified. Median follow-up after initial surgery was 33 months (range: 12–112 months). Sixty-two (76%) were treated successfully with acute treatment and did not return with recurrent infection (cleared infection, group C); 20 (24%) returned later with chronic infection (recurrent infection, group R). Multivariable analysis indicated that patients with stainless steel implants (OR = 6.4, 95% CI = 1.7–32.1; p =.009) and older subjects (OR = 1.3, 95% CI = 1.0–1.6; p =.03) were more likely to present with recurrent infection. There was no difference between the groups with regard to the initial time of presentation post fusion, proportion of non-idiopathic diagnosis, rate of positive cultures, culture species, presence of fusion to pelvis, and time on antibiotic treatment. Conclusions Seventy-six percent of patients presenting with an SSI less than 3 months after PSF did not require implant removal to clear their infection. Early postoperative SSIs can be treated with retention or implant exchange. Older patients and patients with stainless steel instrumentation are more likely to present with a late recurrent infection compared to other metals. Level of Evidence Level III. © Scoliosis Research Society 2016 |
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