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The effect of antibiotic-impregnated calcium sulfate beads and Medical Optimization Clinic attendance on the acute surgical site infection rate in high-risk pediatric neuromuscular and syndromic scoliosis patients

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Abstract

Background

Neuromuscular and syndromic (NMS) scoliosis patients are at higher risk of acute surgical site infections (SSIs). Despite following POSNA’s endorsed consensus-based guidelines for SSI prevention, our institutional rates of acute SSI have varied dramatically. This variability drove simultaneous strategies to lower SSI rates: the creation of a preoperative Medical Optimization Clinic (MOC) and use of antibiotic-impregnated (Abx-I) calcium sulfate beads.

Methods

Patients undergoing index PSF at a single institution between 2016 and 2022 were retrospectively reviewed. Patients with ≥ 2 risk factors were included: (1) BMI < 18.5 or > 25; (2) incontinence; (3) instrumentation to pelvis; (4) non-verbal; (5) GMFCS IV/V. SSI was defined as deep infection within 90 days. We compared patients who attended MOC and received Abx-I (MOC + Abx-I) to those receiving neither intervention (control) nor a single intervention.

Results

282 patients were included. The overall infection rate was 4.26%. Higher GMFCS (p = 0.0147), non-verbal status (p = 0.0048), and longer fusions (p = 0.0298) were independently associated with infection rate. Despite the MOC + Abx-I group having larger Cobb angles (88° ± 26°), higher GMFCS levels (4.5 ± 0.9), ASA class (3 ± 0.4), and more frequent instrumentation to the pelvis (85%), they had the lowest infection rate (2.13%) when compared to the control (4.2%) or single intervention groups (5.7%, 4.6%) (p = 0.9).

Conclusion

The study examined the modern infection rate of NMS patients following the implementation of two interventions: MOC and Abx-I. Despite having higher risk factors (curves (88°), GMFCS level (4.5), ASA class (3), higher % instrumentation to the pelvis (85%)), the patients treated with both interventions demonstrated the lowest infection rate (2.13%).

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Sidney Kimmel Medical College, Thomas Jefferson University Hospital, 1015, Walnut Street, Philadelphia, PA, 19107, United States

    Yashas Reddy & Amy L. McIntosh

  2. Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, United States

    Adam Jamnik & Emily Lachmann

  3. Scottish Rite for Children, Dept of Orthopedics, 2222 Welborn St, Dallas, TX, 75219, United States

    David Thornberg, Megan Johnson, Brandon Ramo & Amy L. McIntosh

  4. School of Medicine, Texas A&M University, 8447 Riverside Parkway, Byran, TX, 77807, United States

    Anne-Marie Datcu

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Contributions

Yashas Reddy, BS: Substantially contributed to the design, data acquisition/interpretation. Drafted and revised critically for important intellectual content. Approved the final version to be published. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Adam Jamnik, MD Substantially contributed to the design, data acquisition/interpretation. Drafted and revised critically for important intellectual content. Approved the final version to be published. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. David Thornberg, BS:Substantially contributed to the design, data acquisition/interpretation. Drafted and revised critically for important intellectual content. Approved the final version to be published. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Anne-Marie Datcu, BS:Substantially contributed to the design, data acquisition/interpretation. Drafted and revised critically for important intellectual content. Approved the final version to be published. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Emily Lachmann, BS:Substantially contributed to the design, data acquisition/interpretation. Drafted and revised critically for important intellectual content. Approved the final version to be published. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Brandon Ramo, MD:Substantially contributed to the design, data acquisition/interpretation. Drafted and revised critically for important intellectual content. Approved the final version to be published. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Megan Johnson, MD:Substantially contributed to the design, data acquisition/interpretation. Drafted and revised critically for important intellectual content. Approval final version to be publish. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Amy L. McIntosh, MD:Substantially contributed to the design, data acquisition/interpretation. Drafted and revised critically for important intellectual content. Approved the final version to be published. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Amy L. McIntosh.

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Conflict of interests

Mr. Yashas Reddy, Dr. Adam Jamnik, Mr. David Thornberg, Dr. Brandon Ramo, and Dr. Megan Johnson have no relevant financial or non-financial interest to disclose. Dr. Amy L McIntosh has no relevant financial or non-financial interest to disclose, however, is a paid speaker for NuVasive.

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Retrospective review was IRB approved prior to initiation (IRB #062015–098).

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Reddy, Y., Jamnik, A., Thornberg, D. et al. The effect of antibiotic-impregnated calcium sulfate beads and Medical Optimization Clinic attendance on the acute surgical site infection rate in high-risk pediatric neuromuscular and syndromic scoliosis patients. Spine Deform 12, 1089–1098 (2024). https://doi.org/10.1007/s43390-024-00837-8

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