Nemours/A.I. duPont Hospital for Children, Wilmington, DE.
Children's Hospital of New Orleans, New Orleans, LA.
J Pediatr Orthop. 2021;41(10):e865-e870. doi: 10.1097/BPO.0000000000001958.
Obesity rates continue to rise among children and adolescents across the globe. A multicenter research consortium composed of institutions in the Southern US, located in states endemic for childhood obesity, was formed to evaluate the effect of obesity on pediatric musculoskeletal disorders. This study evaluates the effect of body mass index (BMI) percentile and socioeconomic status (SES) on surgical site infections (SSIs) and perioperative complications in patients with adolescent idiopathic scoliosis (AIS) treated with posterior spinal fusion (PSF).
Eleven centers in the Southern US retrospectively reviewed postoperative AIS patients after PSF between 2011 and 2017. Each center contributed data to a centralized database from patients in the following BMI-for-age groups: normal weight (NW, 5th to <85th percentile), overweight (OW, 85th to <95th percentile), and obese (OB, ≥95th percentile). The primary outcome variable was the occurrence of an SSI. SES was measured by the Area Deprivation Index (ADI), with higher scores indicating a lower SES.
Seven hundred fifty-one patients were included in this study (256 NW, 235 OW, and 260 OB). OB and OW patients presented with significantly higher ADIs indicating a lower SES (P<0.001). In addition, SSI rates were significantly different between BMI groups (0.8% NW, 4.3% OW, and 5.4% OB, P=0.012). Further analysis showed that superficial and not deep SSIs were significantly different between BMI groups. These differences in SSI rates persisted even while controlling for ADI. Wound dehiscence and readmission rates were significantly different between groups (P=0.004 and 0.03, respectively), with OB patients demonstrating the highest rates. EBL and cell saver return were significantly higher in overweight patients (P=0.007 and 0.002, respectively).
OB and OW AIS patients have significantly greater superficial SSI rates than NW patients, even after controlling for SES.
Level III.
肥胖率在全球儿童和青少年中持续上升。一个由美国南部地区机构组成的多中心研究联盟成立，这些机构所在的州是儿童肥胖的地方性地区，旨在评估肥胖对儿科肌肉骨骼疾病的影响。本研究评估了身体质量指数（BMI）百分位和社会经济地位（SES）对接受后路脊柱融合术（PSF）治疗的青少年特发性脊柱侧凸（AIS）患者手术部位感染（SSI）和围手术期并发症的影响。
美国南部的 11 个中心回顾性分析了 2011 年至 2017 年间接受后路脊柱融合术的青少年特发性脊柱侧凸患者的术后 AIS 患者数据。每个中心都从以下 BMI-年龄组的患者中向集中数据库提供数据：正常体重（NW，第 5 至 <85 百分位），超重（OW，第 85 至 <95 百分位）和肥胖（OB，≥95 百分位）。主要结局变量是 SSI 的发生。SES 通过区域剥夺指数（ADI）来衡量，得分越高表示 SES 越低。
本研究共纳入 751 例患者（NW 组 256 例，OW 组 235 例，OB 组 260 例）。OB 和 OW 患者的 ADI 明显较高，表明 SES 较低（P<0.001）。此外，BMI 组之间的 SSI 发生率差异具有统计学意义（NW 组 0.8％，OW 组 4.3％，OB 组 5.4％，P=0.012）。进一步分析表明，BMI 组之间的浅表而非深部 SSI 发生率存在显著差异。即使控制了 ADI，这些 SSI 发生率的差异仍然存在。组间切口裂开和再入院率差异具有统计学意义（P=0.004 和 0.03，分别），OB 患者的发生率最高。超重患者的 EBL 和细胞保存器返回明显更高（P=0.007 和 0.002，分别）。
即使控制 SES，OB 和 OW AIS 患者的浅表 SSI 发生率明显高于 NW 患者。
III 级。
