• Kei Watanabe, Toru Yamaguchi, Satoshi Suzuki, Teppei Suzuki, Keita Nakayama, Satoru Demura, Yuki Taniguchi, Takuya Yamamoto, Ryo Sugawara, Tatsuya Sato, Kenta Fujiwara, Hideki Murakami, Tsutomu Akazawa, Kenichiro Kakutani, Toru Hirano, Haruhisa Yanagida, Kota Watanabe, Morio Matsumoto, Koki Uno, Toshiaki Kotani, Katsushi Takeshita, Tetsuya Ohara, Noriaki Kawakami, and Japan Spinal Deformity Institute Study Group.
• Department of Orthopaedic Surgery, Niigata University School of Medicine, Niigata City, Niigata, Japan.
• Spine. 2021 Aug 15; 46 (16): 109711041097-1104.

Study DesignA retrospective multicenter study.ObjectiveTo determine the surgical site infection (SSI) rate, associated risk factors, and causative pathogens in pediatric patients with spinal deformity.Summary Of Background DataThere have been no extensive investigations of the risk factors for SSI in Japan.MethodsDemographic data, radiographic findings, and the incidence of SSI were retrospectively analyzed in 1449 pediatric patients who underwent primary definitive fusion surgery for spinal deformity at any of 15 institutions from 2015 to 2017. SSI was defined according to the US Centers for Disease Control and Prevention guideline.ResultsThe incidence of all SSIs was 1.4% and that of deep SSIs was 0.76%. The most common pathogenic microbes were methicillin-resistant staphylococci (n = 5) followed by gram-negative rods (n = 4), methicillin-sensitive staphylococci (n = 1), and others (n = 10). In univariate analysis, younger age, male sex, a diagnosis of kyphosis, type of scoliosis, American Society of Anesthesiologists (ASA) class ≥3, mental retardation urinary incontinence, combined anterior-posterior fusion, greater magnitude of kyphosis, three-column osteotomy, use of blood transfusion, and number of antibiotic administration were associated with the likelihood of SSI (all P < 0.05). Multivariate logistic regression analysis identified the following independent risk factors for SSI: syndromic scoliosis etiology (vs. idiopathic scoliosis; adjusted odds ratio [OR] 16.106; 95% confidence interval [CI] 2.225-116.602), neuromuscular scoliosis etiology (vs. idiopathic scoliosis; adjusted OR 11.814; 95% CI 1.109-125.805), ASA class 3 (vs. class 2; adjusted OR 15.231; 95% CI 1.201-193.178), and administration of antibiotic therapy twice daily (vs. three times daily; adjusted OR 6.121; 95% CI 1.261-29.718).ConclusionThe overall infection rate was low. The most common causative bacteria were methicillin-resistant followed by gram-negative rods. Independent risk factors for SSI in pediatric patients undergoing spinal deformity surgery were scoliosis etiology, ASA class 3, and administration of antibiotic therapy twice daily.Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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