Recurrence of Deep Surgical Site Infection in Cerebral Palsy After Spinal Fusion Is Rare

Amit Jain; Urvij M Modhia; Dolores B Njoku; Suken A Shah; Peter O Newton; Michelle C Marks; Tracey P Bastrom; Firoz Miyanji; Paul D Sponseller

doi:10.1016/j.jspd.2016.12.004

Recurrence of Deep Surgical Site Infection in Cerebral Palsy After Spinal Fusion Is Rare

Spine Deform. 2017 May;5(3):208-212. doi: 10.1016/j.jspd.2016.12.004.

Authors

Amit Jain¹, Urvij M Modhia¹, Dolores B Njoku¹, Suken A Shah², Peter O Newton³, Michelle C Marks⁴, Tracey P Bastrom³, Firoz Miyanji⁵, Paul D Sponseller⁶

Affiliations

¹ Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA.
² Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA.
³ Department of Orthopedics, Rady Children's Hospital of San Diego, 3020 Children's Way, San Diego, CA 92123, USA.
⁴ Setting Scoliosis Straight Foundation, 2535 Camino Del Rio S., San Diego, CA 92108, USA.
⁵ British Columbia Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada.
⁶ Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD 21287, USA. Electronic address: psponse@jhmi.edu.

PMID: 28449964
DOI: 10.1016/j.jspd.2016.12.004

Abstract

Study design: Retrospective review of prospective registry.

Objectives: To assess the following in children with cerebral palsy (CP) who develop deep surgical site infection (DSSI) after spinal fusion: (1) rate of infection recurrence after treatment; (2) treatments used; (3) radiographic outcomes; and (4) differences in Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) scores versus those of children with no infection (NI).

Summary of background data: Studies show high rates of surgical site infection in patients with CP but do not address late recurrence or quality-of-life effects.

Methods: One hundred fifty-one children with CP underwent spinal fusion surgery from 2008 through 2011 and had ≥2-year follow-up. Patients who developed DSSI were compared with patients with NI. Student t tests were used to analyze deformity; analysis of variance was used to analyze CPCHILD scores in both groups preoperatively and at final follow-up.

Results: Eleven patients developed DSSI. Causative organisms were polymicrobial infection (5 cases), Escherichia coli (2 cases), and Proteus mirabilis, Staphylococcus aureus, Enterococcus faecalis, and Peptostreptococcus (1 case each). All patients underwent irrigation and debridement and received at least 6 weeks of antibiotics. Six had negative-pressure-dressing-assisted wound closure; 5 had primary closure. At mean 4-year follow-up (range, 3-5 years) no patient had recurrent infection. From immediate postoperative to final follow-up, no patient had significant loss of coronal curve (p = .77) or pelvic obliquity (p = .71) correction. However, at final follow-up, comfort and emotions, overall quality-of-life, and total CPCHILD scores in the DSSI group were significantly lower compared with the NI group (p = .005, .022, and .026, respectively).

Conclusions: In children with CP who developed DSSI after spinal fusion, there was no recurrence of infection or deformity after infection treatment. CPCHILD scores in patients with DSSI were lower compared with the NI group.

Keywords: Cerebral palsy; Deep surgical site infection; Health-related quality of life; Level II; Recurrence; Spinal fusion.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Anti-Bacterial Agents / therapeutic use
Cerebral Palsy / surgery*
Child
Female
Humans
Male
Postoperative Period
Prospective Studies
Recurrence
Registries
Retrospective Studies
Spinal Fusion / adverse effects*
Surgical Wound Infection / drug therapy
Surgical Wound Infection / microbiology
Surgical Wound Infection / pathology*
Young Adult

Substances

Anti-Bacterial Agents