Variability of Surgical Site Infection With VEPTR at Eight Centers: A Retrospective Cohort Analysis

Sumeet Garg; Micaela Cyr; Tricia St Hilaire; Tara Flynn; Patrick Carry; Michael Glotzbecker; John T Smith; Jeffrey Sawyer; Joshua Pahys; Scott Luhmann; John M Flynn; Ron El-Hawary; Michael Vitale

doi:10.1016/j.jspd.2015.07.009

Variability of Surgical Site Infection With VEPTR at Eight Centers: A Retrospective Cohort Analysis

Spine Deform. 2016 Jan;4(1):59-64. doi: 10.1016/j.jspd.2015.07.009. Epub 2015 Dec 23.

Authors

Affiliations

¹ University of Colorado, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA. Electronic address: sumeet.garg@childrenscolorado.org.
² University of Colorado, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA.
³ Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA.
⁴ Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA; Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
⁵ Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA; Primary Children's Medical Center, 100 North Mario Capecchi Drive, Salt Lake City, UT 84113, USA.
⁶ Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA; University of Tennessee, Campbell Clinic, 1211 Union Avenue, Memphis, TN 38104, USA.
⁷ Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA; Shriners Hospital for Children, 3551 North Broad Street, Philadelphia, PA 19140, USA.
⁸ Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA; Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
⁹ Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA; The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
¹⁰ Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA; IWK Health Centre, 5980 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada.
¹¹ Children's Spine Study Group, P.O. Box 397, Valley Forge, PA 19481, USA; Children's Hospital of New York, 3959 Broadway, New York, NY 10032, USA.

PMID: 27852502
DOI: 10.1016/j.jspd.2015.07.009

Abstract

Study design: Retrospective review.

Objectives: To describe clinical characteristics and infection rates in modern vertical expandable prosthetic titanium rib (VEPTR) surgery.

Summary of background data: Prior studies have demonstrated infection rates from 10% to 30% with VEPTR surgery.

Methods: A retrospective query was done on an institutional review board-approved, multicenter prospectively collected database for patients implanted with VEPTR from 2007 to 2013 at eight sites. This identified 213 patients with appropriate data for analysis. Average follow-up was 4.1 years (range 1.7-6.3). Data collected included a Classification of Early-Onset Scoliosis (C-EOS) diagnosis, American Society of Anesthesiologists Physical Status (ASA-PS), major Cobb angle, construct type, clinical symptoms, and microbiology. The distribution of infection rates across all the study sites was compared. The exact p value was estimated by Monte Carlo simulation.

Results: Overall, 18% (38/213) of patients implanted with VEPTR developed infection requiring operative debridement. There were significantly different infection rates among the sites, ranging from 2.9% to 42.9% (p = .029). The average time to infection was 70 days (range 8-236) after the infecting procedure. The majority of infections were due to gram-positive bacteria (80%, 44/55), the most prevalent being methicillin-sensitive Staphylococcus aureus (45%, 25/55). There were 20 patients (53%, 20/38) with either partial or complete implant removal to resolve infection; however, only 3 of 38 (8%) of these resulted in abandonment of VEPTR treatment. There was no difference in infection rate across the primary C-EOS diagnosis categories (p = .21) or based on ASA score (p = .53). After controlling for study site, the odds ratio of an infection following an implant procedure versus an expansion was 2.8 (p = .002). There was no difference in the odds ratio of an infection between the other procedure types (implant, expansion, exchange/revision).

Conclusions: There were significant differences in infection rates between sites. The variability in infection rate indicates a need for guided efforts to standardize best practices for infection control in VEPTR surgery.

Level of evidence: III, therapeutic study.

Keywords: Early-onset scoliosis; Infection; VEPTR.

MeSH terms

Humans
Retrospective Studies
Ribs
Scoliosis / surgery*
Spinal Fusion / adverse effects*
Surgical Wound Infection*
Titanium

Substances

Titanium