Surgical site infections in pediatric spinal surgery after implementation of a quality assurance program.
Surgical site infections in pediatric spinal surgery after implementation of a quality assurance program.
复制标题
实施质量保证计划后小儿脊柱手术的手术部位感染。
DOI：
10.1007/s43390-020-00192-4
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发表时间：
2021
期刊：
影响因子：
1.6
通讯作者：
Vitale,MichaelG
中科院分区：
文献类型：
--
作者：
Hammoor,Bradley;Matsumoto,Hiroko;Marciano,Gerard;Dziesinski,Lucas;Wang,Kevin;Roye,BenjaminD;Roye,DavidP;Vitale,MichaelG
研究设计回顾性队列研究。目的评估两种减少感染方案在降低我们机构脊柱畸形手术后儿科患者术后手术部位感染（SSI）发生率方面的有效性。背景数据摘要脊柱畸形手术后的感染与较高的发病率以及显着增加的医疗费用相关。神经肌肉病因患者的 SSI 特别高，骨髓增生异常患者超过 8%，脑瘫患者超过 6%。方法对我们机构 2008 年至 2018 年间 1200 名患者的 1934 例儿科脊柱手术进行了手动图表审查。年龄在 0 至 21 岁之间接受过任何脊柱外科手术（包括延长生长棒）的患者都包括在内。结果制定了两个独立的减少感染计划根据年龄和仪器水平数量进行调整后，该人群的 SSI 风险降低了 65.4%（风险比 [RR] = 0.3，95% 置信区间 [CI] = 0.2；0.6，p= 0.001）。在调整年龄和仪器水平数量后，与接受其他类型外科手术的患者相比，接受初始仪器治疗的患者 SSI 风险降低了 68.8%（RR = 0.3，95% CI 0.2；0.6，p= 0.002）。据观察，这些减少感染计划的效果随着时间的推移而减弱。我们机构之前实施的计划也观察到了这种效果。 结论 在实施两项减少感染计划后，SSI 的发生率有所下降，特别是在接受初始器械操作的患者中。然而，时间序列分析表明，这些计划可能在实施后立即产生最大效果，但随着时间的推移而减弱。证据级别 III 级。
Study DesignRetrospective cohort study.ObjectiveTo assess the effectiveness of two infection-reducing programs in mitigating the incidence of post-operative surgical site infections (SSI) in pediatric patients after spinal deformity surgery at our institution.Summary of background dataInfections following spinal deformity surgery are associated with higher morbidity as well as significantly increased healthcare costs. SSI in patients with neuromuscular etiologies is especially high, exceeding 8 percent for myelodysplasia patients and 6 percent for cerebral palsy patients.MethodsManual chart review was conducted for 1934 pediatric spine procedures in 1200 patients at our institution between 2008 and 2018. Patients between the ages of 0 and 21 having any spinal surgical procedure including lengthening of growing rods were included.ResultsInstitution of two separate infection-reducing programs reduced risk of SSI in this population by 65.4%, when adjusted for age and number of instrumentation levels (risk ratio [RR] = 0.3, 95% confidence interval [CI] = 0.2; 0.6,p= 0.001). Patients undergoing Initial Instrumentation demonstrated 68.8% less risk of SSI compared to those who had other types of surgical procedures, after adjusting for age and the number of level instrumented (RR = 0.3, 95% CI 0.2; .6,p= 0.002). It was observed that the effect of each of these infection-reducing programs diminished with time. This effect was also observed with prior programs implemented at our institution.ConclusionThe incidence of SSI decreased following the implementation of two infection-reducing programs especially in patients undergoing Initial Instrumentation procedures. However, time-series analysis suggests these programs may have maximal effect immediately following institution that diminishes with time.Level of evidenceLevel III.