Variability of Surgical Site Infection With VEPTR at Eight Centers: A Retrospective Cohort Analysis

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• 作者：Sumeet Garg ; MD^a ; ^{sumeet.garg@childrenscolorado.org" class="auth_mail" title="E-mail the corresponding author} ; Micaela Cyr ; BA^a ; Tricia St. Hilaire ; MPH^b ; Tara Flynn ; BA^b ; Patrick Carry ; BA^a ; Michael Glotzbecker ; MD^b ; ^c ; John T. Smith ; MD^b ; ^d ; Jeffrey Sawyer ; MD ; FAAOS^b ; ^e ; Joshua Pahys ; MD^b ; ^f ; Scott Luhmann ; MD^b ; ^g ; John M. Flynn ; MD^b ; ^h ; Ron El-Hawary ; MD ; MSc ; FRCS(C)^b ; ⁱ ; Michael Vitale ; MD ; MPH^b ; ^j
• 关键词：Early-onset scoliosis ; VEPTR ; Infection
• 刊名：Spine Deformity
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：4
• 期：1
• 页码：59-64
• 全文大小：506 K

文摘

Retrospective review.

Objectives

To describe clinical characteristics and infection rates in modern vertical expandable prosthetic titanium rib (VEPTR) surgery.

Summary of Background Data

Prior studies have demonstrated infection rates from 10% to 30% with VEPTR surgery.

Methods

A retrospective query was done on an institutional review board–approved, multicenter prospectively collected database for patients implanted with VEPTR from 2007 to 2013 at eight sites. This identified 213 patients with appropriate data for analysis. Average follow-up was 4.1 years (range 1.7–6.3). Data collected included a Classification of Early-Onset Scoliosis (C-EOS) diagnosis, American Society of Anesthesiologists Physical Status (ASA-PS), major Cobb angle, construct type, clinical symptoms, and microbiology. The distribution of infection rates across all the study sites was compared. The exact p value was estimated by Monte Carlo simulation.

Results

Overall, 18% (38/213) of patients implanted with VEPTR developed infection requiring operative debridement. There were significantly different infection rates among the sites, ranging from 2.9% to 42.9% (p = .029). The average time to infection was 70 days (range 8–236) after the infecting procedure. The majority of infections were due to gram-positive bacteria (80%, 44/55), the most prevalent being methicillin-sensitive Staphylococcus aureus (45%, 25/55). There were 20 patients (53%, 20/38) with either partial or complete implant removal to resolve infection; however, only 3 of 38 (8%) of these resulted in abandonment of VEPTR treatment. There was no difference in infection rate across the primary C-EOS diagnosis categories (p = .21) or based on ASA score (p = .53). After controlling for study site, the odds ratio of an infection following an implant procedure versus an expansion was 2.8 (p = .002). There was no difference in the odds ratio of an infection between the other procedure types (implant, expansion, exchange/revision).

Conclusions

There were significant differences in infection rates between sites. The variability in infection rate indicates a need for guided efforts to standardize best practices for infection control in VEPTR surgery.

Level of Evidence

III, therapeutic study.