Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 USA.
Lewis Katz School of Medicine at Temple University, 3500 N Broad St, Philadelphia, PA 19140 USA.
Spine J. 2021 Apr;21(4):664-670. doi: 10.1016/j.spinee.2020.12.004. Epub 2020 Dec 23.
Surgical site infections (SSIs) are medically devastating and financially costly complications after posterior spinal fusion (PSF) for neuromuscular scoliosis (NMS). Many strategies exist to reduce their occurrence. The efficacy of intraoperative antibiotics in the wound or bone graft is gaining in popularity, but this practice has not been well-studied in the PSF NMS population.
To assess the potential utility of intraoperative local antibiotics in patients with NMS undergoing PSF.
STUDY DESIGN/SETTING: Retrospective review of prospectively collected data.
Pediatric patients who underwent PSF for NMS were identified from the 2016-2018 National Surgical Quality Improvement Program (NSQIP) pediatric spinal fusion datasets.
Perioperative adverse outcome variables assed included the occurrence of SSI, renal complications, and adverse hospital metrics.
Patient demographic factors, comorbidities, and the use of intraoperative antibiotics in the wound were recorded (a specifically assessed variable in the dataset). The association between the use of intraoperative antibiotics and the occurrence of adverse outcomes/infection was assessed for the entire study population and higher risk sub-populations.
In total, 1,990 patients met the inclusion criteria, of which 87% received local antibiotics. Higher risk patients were more likely to receive local antibiotics in the wound as part of their procedure. When controlling for potentially confounding factors, the use of local antibiotics was not statistically significantly associated with any of the studied adverse outcomes for the overall study population. Subgroup analysis of higher risk patient populations (≥13 levels fused, osteotomy performed, prior deformity surgery, nonasthma lung condition) revealed a significantly decreased risk of SSI in patients undergoing ≥13 level fusions (relative risk: 0.48, 95% confidence interval: 0.25-0.91).
With no increased overall risks and reduced SSIs in higher risk NMS patients undergoing PSF, the use of intrawound antibiotics appears to be supported by this dataset.
手术后部位感染（SSI）是神经肌肉性脊柱侧凸（NMS）后路脊柱融合（PSF）后具有破坏性的医学并发症，且耗费大量财力。有许多策略可以降低其发生率。局部抗生素在伤口或骨移植物中的疗效越来越受到关注，但在 NMS 患者的 PSF 人群中，这种方法尚未得到充分研究。
评估术中局部抗生素在接受 PSF 的 NMS 患者中的潜在应用价值。
研究设计/设置：前瞻性收集数据的回顾性研究。
从 2016 年至 2018 年国家手术质量改进计划（NSQIP）儿科脊柱融合数据集，确定了接受 PSF 治疗 NMS 的儿科患者。
围手术期不良结局变量包括 SSI、肾功能并发症和不良医院指标的发生。
记录患者的人口统计学因素、合并症和伤口内使用的术中抗生素（数据集内专门评估的变量）。评估术中抗生素的使用与整个研究人群和高风险亚人群不良结局/感染发生之间的关联。
共有 1990 例患者符合纳入标准，其中 87%接受了局部抗生素。高危患者更有可能在手术过程中接受伤口内局部抗生素。在控制可能存在的混杂因素后，局部抗生素的使用与研究人群的任何不良结局均无统计学显著相关性。对高危人群（融合≥13 个节段、进行截骨术、既往畸形手术、非哮喘肺部疾病）的亚组分析显示，接受≥13 个节段融合的患者 SSI 风险显著降低（相对风险：0.48，95%置信区间：0.25-0.91）。
在接受 PSF 的高风险 NMS 患者中，局部抗生素的使用并未增加总体风险，且降低了 SSI 的发生率，因此，该数据集支持使用这种方法。
