SCOLIOSIS SURGICAL SITE INFECTION – FIVE YEAR SINGLE SURGEON SERIES

Abstract

Purpose of study: Evaluate our surgical site infection (SSI) rate in scoliosis surgery against nationally agreed standards, examine local practices to limit SSI and compare metalwork survivorship in the presence of infection.

Methods and Results : Retrospective analysis of patients undergoing instrumented correction of scoliosis with or without fusion between September 2003 and January 2009. Clinical and laboratory records of 134 patients (age range 10 months to 22 years) were examined for any evidence of SSI. There were 14 (10.4%) SSI cases, of which 8 (5.9%) were clinically significant deep SSIs, which is slightly higher than a pooled SSI rate of 2.2% from a meta-analysis of infection in spinal surgery (range 1.2 to 8.5%)1. Half of our deep SSIs occurred in neuromuscular scoliosis corrections with the most prevalent pathogen being E. Coli (28%) overall. All deep SSI patients underwent surgical debridement and iv antibiotics and we were able to retain the metalwork in all early (within 21 days) SSIs (6 of 8) but in neither late SSI (588 and 814 days). No single common variable was identified from our data-set as a risk factor for SSI although high staff numbers in theatre was noted. Infection rate increased toward the end of our series which coincided with a change in antibiotic prophylaxis protocol and paradoxically with a move to a laminar flow theatre.

Conclusion : Our SSI rate in scoliosis surgery was not significantly higher than previously published pooled rates. No single common variable was identified as risk factor for SSI. An empirical return to previous antibiotic prophylaxis could be recommended along with limiting staff numbers and movements within the operating theatre.

Ethics approval: Audit/service standard in trust

Conflict of Interest Statement: None