Baranek Eric S, Maier Stephen P, Matsumoto Hiroko, Hyman Joshua E, Vitale Michael G, Roye David P, Roye Benjamin D
Children's Hospital of New York, Columbia University Medical Center, New York, NY.
J Pediatr Orthop. 2019 Apr;39(4):e298-e302. doi: 10.1097/BPO.0000000000001285.
There is currently minimal evidence that preoperative malnutrition increases surgical site infection (SSI) risk in children with cerebral palsy (CP) undergoing spinal deformity surgery. Growth charts specifically for patients with CP have been created to aid in the clinical interpretation of body mass index (BMI) as a marker of nutritional status, but to our knowledge these charts have never been used to risk stratify patients before orthopaedic surgery. We hypothesize that patients with CP who have BMI-for-age below the 10th percentile (BMI≤10) on CP-specific growth charts are at increased risk of surgical site infection following spinal deformity surgery compared with patients with BMI-for-age above the 10th percentile (BMI>10).
Single-center, retrospective review comparing the rate of SSI in patients with CP stratified by BMI-for-age percentiles on CP-specific growth charts who underwent spinal deformity surgery. Odds ratios with 95% confidence intervals and Pearson χ tests were used to analyze the association of the measured nutritional indicators with SSI.
In total, 65 patients, who underwent 74 procedures, had complete follow-up data and were included in this analysis. Ten patients (15.4%) were GMFCS I-III and 55 (84.6%) were GMFCS IV-V; 39 (60%) were orally fed and 26 (40%) were tube-fed. The rate of SSI in this patient population was 13.5% with 10 SSIs reported within 90 days of surgery. There was a significant association between patients with a BMI below the 10th percentile on GMFCS-stratified growth charts and the development of SSI (OR, 13.6; 95% CI, 2.4-75.4; P=0.005). All SSIs occurred in patients that were GMFCS IV-V. There was no association between height, weight, feeding method, or pelvic instrumentation and development of SSI.
CP-specific growth charts are useful tools for identifying patients at increased risk for SSI following spinal instrumentation procedures, whereas standard CDC growth charts are much less sensitive. There is a strong association between preoperative BMI percentile on GMFCS-stratified growth charts and SSI following spinal deformity surgery.
Level III-Retrospective Study.
目前，几乎没有证据表明术前营养不良会增加接受脊柱畸形手术的脑瘫（CP）患儿手术部位感染（SSI）的风险。专门为CP患者创建了生长图表，以帮助临床解释作为营养状况指标的体重指数（BMI），但据我们所知，这些图表从未用于骨科手术前对患者进行风险分层。我们假设，与年龄别BMI高于第10百分位数（BMI>10）的CP患者相比，在CP特异性生长图表上年龄别BMI低于第10百分位数（BMI≤10）的CP患者在脊柱畸形手术后发生手术部位感染的风险增加。
进行单中心回顾性研究，比较根据CP特异性生长图表上的年龄别BMI百分位数分层的接受脊柱畸形手术的CP患者的SSI发生率。使用95%置信区间的比值比和Pearson χ检验分析所测量的营养指标与SSI之间的关联。
共有65例接受了74次手术的患者有完整的随访数据并纳入本分析。10例患者（15.4%）为GMFCS I-III级，55例（84.6%）为GMFCS IV-V级；39例（60%）经口喂养，26例（40%）经管饲喂养。该患者群体的SSI发生率为13.5%，在手术后90天内报告了10例SSI。在GMFCS分层生长图表上BMI低于第10百分位数的患者与SSI的发生之间存在显著关联（比值比，13.6；95%置信区间，2.4-75.4；P=0.005）。所有SSI均发生在GMFCS IV-V级患者中。身高、体重、喂养方式或骨盆内固定与SSI的发生之间无关联。
CP特异性生长图表是识别脊柱内固定手术后发生SSI风险增加患者的有用工具，而标准的美国疾病控制与预防中心（CDC）生长图表敏感性要低得多。GMFCS分层生长图表上的术前BMI百分位数与脊柱畸形手术后的SSI之间存在密切关联。
III级——回顾性研究。
