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Incidence and risk factors for early wound complications after spinal arthrodesis in children: analysis of 30-day follow-up data from the ACS-NSQIP
Journal article   Peer reviewed

Incidence and risk factors for early wound complications after spinal arthrodesis in children: analysis of 30-day follow-up data from the ACS-NSQIP

Christopher T Martin, Andrew J Pugely, Yubo Gao, Ryan M Ilgenfritz and Stuart L Weinstein
Spine (Philadelphia, Pa. 1976), Vol.39(18), pp.1463-1470
08/15/2014
DOI: 10.1097/BRS.0000000000000446
PMID: 24875961

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Abstract

Retrospective review of prospectively collected data. To determine the incidence and risk factors for 30-day wound complication after spinal arthrodesis in pediatric patients. Although multiple prior studies have reported on wound complications in pediatric spine, the majority have been single-center retrospective series. The National Surgical Quality Improvement Program (NSQIP) employs on-site personnel to prospectively collect 30-day morbidity data from 50 pediatric centers. Year 2012 was the first year of enrollment, and 1915 cases with thoracic or lumbar spinal fusion were included. Patients were divided into cohorts of those with and without a wound complication, with univariate and multivariate analyses used to identify risk factors. A P value of less than 0.05 was considered significant. Wound complications occurred in 67 patients (3.5%). The incidence was significantly higher in patients with congenital (4.35%) or neuromuscular (4.67%) diagnoses, as opposed to idiopathic (2.7%) or infantile (1.61%). Procedures with fusions extending to the pelvis (9.91%) or an osteotomy (4.99%) were associated with higher risk. Longer hospital lengths of stay, increased operative time, increased patient body mass index, and patients with cardiac, gastrointestinal, neurological, or pulmonary comorbidities were also associated with a higher risk. In the multivariate analysis, a body mass index of more than 30 kg/m2, patients with cardiac risk factors, and fusions extending to the pelvis were independent risk factors. Data from this large prospective multicenter study confirm that the incidence of early wound complications in pediatric spine surgery is low. Patients with a fusion extending to the pelvis, obese patients, and patients with significant cardiac conditions were independently associated with higher risk for this complication. These data should be useful for patients' counseling and for preoperative risk stratification. Interventions for minimizing wound complication risk may be most applicable to the high-risk groups identified here. 2.
 Comorbidity Multivariate Analysis United States - epidemiology Prospective Studies Follow-Up Studies Humans Child, Preschool Male Incidence Thoracic Vertebrae - surgery Lumbar Vertebrae - surgery Multicenter Studies as Topic Heart Diseases - epidemiology Time Factors Female Retrospective Studies Child Body Mass Index Length of Stay Spinal Fusion - methods Surgical Wound Infection - epidemiology Risk Factors Logistic Models Surgical Wound Infection - etiology Adolescent

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