Deep Surgical Site Infection Following 2344 Growing-Rod Procedures for Early-Onset Scoliosis

Abstract. The aim of this study was to determine the incidence, annual trend, and perioperative outcomes and identify risk factors of early-onset (≤90 d) deep surgical site infection (SSI) following primary total hip arthroplasty (THA) for osteoarthritis. We performed a retrospective study using prospectively collected patient-level data from January 2013 to March 2020. The diagnosis of deep SSI was based on the published Centre for Disease Control/National Healthcare Safety Network (CDC/NHSN) definition. The Mann–Kendall trend test was used to detect monotonic trends. Secondary outcomes were 90 d mortality and 90 d readmission. A total of 22 685 patients underwent primary THA for osteoarthritis. A total of 46 patients had a confirmed deep SSI within 90 d of surgery representing a cumulative incidence of 0.2 %. The annual infection rate decreased over the 7-year study period (p=0.026). Risk analysis was performed on 15 466 patients. Risk factors associated with early-onset deep SSI included a BMI > 30 kg m−2 (odds ratio (OR) 3.42 [95 % CI 1.75–7.20]; p<0.001), chronic renal disease (OR, 3.52 [95 % CI 1.17–8.59]; p=0.011), and cardiac illness (OR, 2.47 [1.30–4.69]; p=0.005), as classified by the Canadian Institute for Health Information. Early-onset deep SSI was not associated with 90 d mortality (p=0.167) but was associated with an increased chance of 90 d readmission (p<0.001). This study establishes a reliable baseline infection rate for early-onset deep SSI after THA for osteoarthritis through the use of a robust methodological process. Several risk factors for early-onset deep SSI are potentially modifiable, and therefore targeted preoperative interventions of patients with these risk factors is encouraged.

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Correlation between surgical site infection and classification of early onset scoliosis (C-EOS) in patients managed by rib-based distraction instrumentation

Spine Deformity ◽

10.1007/s43390-020-00103-7 ◽

2020 ◽

Vol 8 (4) ◽

pp. 787-792

Author(s):

Patrick J. Cahill ◽

Mahmoud A. Mahmoud ◽

Elle M. MacAlpine ◽

Aaron M. Tatad ◽

Robert M. Campbell ◽

...

Keyword(s):

Surgical Site Infection ◽

Early Onset ◽

Early Onset Scoliosis ◽

Site Infection

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Paper #31 Development of a Risk Severity Score Predicting Surgical Site Infection in Early Onset Scoliosis

Spine Deformity ◽

10.1016/j.jspd.2016.09.036 ◽

2016 ◽

Vol 4 (6) ◽

pp. 460-461

Author(s):

Michael Vitale ◽

Hiroko Matsumoto ◽

Nicholas Feinberg ◽

John Smith ◽

Amer Samdani ◽

...

Keyword(s):

Surgical Site Infection ◽

Severity Score ◽

Early Onset ◽

Early Onset Scoliosis ◽

Site Infection

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Calcium sulfate antibiotic‐impregnated bead implantation for deep surgical site infection associated with orthopedic surgery in small animals

Veterinary Surgery ◽

10.1111/vsu.13570 ◽

2021 ◽

Author(s):

Lindsay C. Peterson ◽

Stanley E. Kim ◽

Daniel D. Lewis ◽

Matthew D. Johnson ◽

Cassio R. A. Ferrigno

Keyword(s):

Surgical Site Infection ◽

Orthopedic Surgery ◽

Calcium Sulfate ◽

Small Animals ◽

Site Infection ◽

Deep Surgical Site Infection

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Incidence, Management and Outcome of Delayed Deep Surgical Site Infection Following Spinal Deformity Surgery: 20-Year Experience at a Single Institution

Global Spine Journal ◽

10.1177/2192568220978225 ◽

2020 ◽

pp. 219256822097822

Author(s):

Muyi Wang ◽

Liang Xu ◽

Bo Yang ◽

Changzhi Du ◽

Zezhang Zhu ◽

...

Keyword(s):

Surgical Site Infection ◽

Spinal Deformity ◽

Recurrent Infection ◽

Implant Removal ◽

Site Infection ◽

Initial Surgery ◽

Spinal Deformity Surgery ◽

Solid Fusion ◽

Deep Surgical Site Infection

Study Design: A retrospective study. Objectives: To investigate the incidence, management and outcome of delayed deep surgical site infection (SSI) after the spinal deformity surgery. Methods: This study reviewed 5044 consecutive patients who underwent spinal deformity corrective surgery and had been followed over 2 years. Delayed deep SSI were defined as infection involving fascia and muscle and occurring >3 months after the initial procedure. An attempt to retain the implant were initially made for all patients. If the infection failed to be eradicated, the implant removal should be put off until solid fusion was confirmed, usually more than 2 years after the initial surgery. Radiographic data at latest follow-up were compared versus that before implant removal. Results: With an average follow-up of 5.3 years, 56 (1.1%) patients were diagnosed as delayed deep SSI. Seven (12.5%) patients successfully retained instrumentation and there were no signs of recurrence during follow-up (average 3.4 years). The remaining patients, because of persistent or recurrent infection, underwent implant removal 2 years or beyond after the primary surgery, and solid fusion was detected in any case. However, at a minimum 1-year follow-up (average 3.9 years), an average loss of 9° in the thoracic curve and 8° in the thoracolumbar/lumbar curves was still observed. Conclusions: Delayed deep SSI was rare after spinal deformity surgery. To eradicate infection, complete removal of implant may be required in the majority of delayed SSI. Surgeons must be aware of high likelihood of deformity progression after implant removal, despite radiographic solid fusion.

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Analysis of serum levels of titanium and aluminium ions in patients with early onset scoliosis operated upon using the magnetic growing rod—a single centre study of 14 patients

Spine Deformity ◽

10.1007/s43390-021-00335-1 ◽

2021 ◽

Author(s):

Mandar Deepak Borde ◽

Sarang Sapare ◽

Emile Schutgens ◽

Chadi Ali ◽

Hilali Noordeen

Keyword(s):

Early Onset ◽

Serum Levels ◽

Early Onset Scoliosis ◽

Ion Concentration ◽

Long Term Effects ◽

Blood Concentrations ◽

Growing Rod ◽

Rod System ◽

Rod Breakage

Abstract Study design A cross-sectional retrospective Level 3 study. Objective To study the serum levels of Titanium and Aluminium ions in patients operated using the magnetically controlled growing rod (MCGR) system. Summary of background data 14 consecutive patients of early onset scoliosis with varying etiology managed with MCGR system with a minimum follow-up of 24 months were selected for the study. The group consisted of two boys (14.3%) and 12 girls (85.7%). The average age of the patients at the time of surgery was 10.4 years (5–15 years). The average period of follow-up was 43.7 months (28–79 months). After informed consent of the subjects and their caretakers, serum levels of titanium and aluminium were measured. These levels were then assessed with regards to the number of screws used, number of distractions and complications. Methods The concentration of titanium and aluminium ions in the serum was measured using high resolution inductively coupled plasma mass spectrometry. Results For the sake of ease of assessment, patients were divided into three etiology-based groups—idiopathic (n = 6), neuromuscular (n = 2) and syndromic (n = 6). The mean serum titanium level was 15.9 μg/L (5.1–28.2 μg/L) while that of aluminium was 0.1 μmol/L (0.1–0.2 μmol/L). Of the 14 patients, 2 (14.2%) patients had mechanical failure (actuator pin dysfunction), 3 (21.4%) had rod breakage requiring revision surgery and one patient (7.1%) had surgical site infection managed with appropriate antibiotics. Patients undergoing revision for rod breakage did not show any metallosis of the tissues during surgery. Conclusion Analysis of patients with scoliosis operated using the magnetic growing rod system concludes that it is accompanied by presence of titanium in the blood but whether clinically significant or not needs to be ascertained by comparison of preoperative and postoperative blood concentrations of the titanium ions in individual subjects. The aluminium ion concentration remains within normal limits. Though implant malfunction may raise the titanium levels in the blood, its clinical significance needs to be determined. The aluminium levels are not affected irrespective to the presence or absence of complications. The long-term effects of raised titanium levels in the blood also warrant further prospective studies designed for precise and deeper analyses.

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