Desai Virendra R, Raskin Jeffrey S, Mohan Arvind, Montojo JoWinsyl, Briceño Valentina, Curry Daniel J, Lam Sandi
J Neurosurg Pediatr. 2018 Apr;21(4):395-400. doi: 10.3171/2017.10.PEDS17248. Epub 2018 Jan 26.
OBJECTIVE Intrathecal baclofen pumps are generally placed in children for the treatment of spasticity and dystonia. Use of implants in this pediatric population with comorbidities is reported to have a high risk of complications and infections. With the aim of reducing baclofen pump-related infections, a quality improvement project was instituted at the authors' institution. METHODS A workflow paradigm unique to baclofen pump implantation aimed at decreasing implant-related infections was implemented. All baclofen pump operations performed at the authors' institution between August 2012 and June 2016 were reviewed. An infection prevention protocol was created and implemented in August 2014 based on a literature review and the consensus opinion of the pediatric neurosurgeons in the group. Compliance with the prevention bundle was tracked. Case outcomes before and after implementation of the protocol with a minimum of 3 months of follow-up were retrospectively reviewed. Univariate and multivariate analyses were performed to assess the association of the steps in the prevention bundle with infection and complication outcomes. RESULTS A total of 128 baclofen pump surgeries were performed (64 preprotocol and 64 postprotocol). The patient age range was 3 to 27 years. The overall compliance rate with the infection prevention bundle was 82%. The pre- and postimplementation infection rates were 12.5% and 6.3%, respectively (p = 0.225). The total pre- and postimplementation complication rates were 23.4% and 9.4%, respectively (p = 0.032). The absolute and relative risk reductions for infections were 6.3% (95% CI 3.8%-16.3%) and 50%, respectively; for complications, the absolute and relative risk reductions were 14.1% (95% CI 1.5%-26.7%) and 60%, respectively. CONCLUSIONS The total complication rate following intrathecal baclofen pump surgery was significantly lower after implementation of the quality improvement protocol. This study is an example of using checklist standardization to diminish special cause variability.
目的 鞘内注射巴氯芬泵通常用于儿童痉挛和肌张力障碍的治疗。据报道，在患有合并症的儿科患者中使用植入物会有较高的并发症和感染风险。为了降低与巴氯芬泵相关的感染风险，作者所在机构开展了一项质量改进项目。方法 实施了一种巴氯芬泵植入特有的工作流程模式，旨在减少植入相关感染。回顾了2012年8月至2016年6月在作者所在机构进行的所有巴氯芬泵手术。基于文献综述和该组儿科神经外科医生的共识意见，于2014年8月制定并实施了感染预防方案。跟踪对预防措施组合的依从性。对方案实施前后至少随访3个月的病例结果进行回顾性分析。进行单因素和多因素分析，以评估预防措施组合中的步骤与感染和并发症结果之间的关联。结果 共进行了128例巴氯芬泵手术（方案实施前64例，方案实施后64例）。患者年龄范围为3至27岁。感染预防措施组合的总体依从率为82%。实施前和实施后的感染率分别为12.5%和6.3%（p = 0.225）。实施前和实施后的总并发症发生率分别为23.4%和9.4%（p = 0.032）。感染的绝对和相对风险降低分别为6.3%（95%CI 3.8%-16.3%）和50%；对于并发症，绝对和相对风险降低分别为分别为14.1%（95%CI 1.5%-26.7%）和60%。结论 实施质量改进方案后，鞘内注射巴氯芬泵手术后的总并发症发生率显著降低。本研究是使用检查表标准化来减少特殊原因变异的一个实例。
