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Spine Deform. 2019 Jan;7(1):33-39. doi: 10.1016/j.jspd.2018.06.010.

Implementing a Multidisciplinary Clinical Pathway Can Reduce the Deep Surgical Site Infection Rate After Posterior Spinal Fusion in High-Risk Patients.

Author information

1
Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA. Electronic address: Michael.Glotzbecker@childrens.harvard.edu.
2
Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA.

Abstract

DESIGN:

Retrospective comparative study.

OBJECTIVE:

The purpose of this study is to measure SSI outcomes before and after implementation of our center's multidisciplinary clinical pathway protocol for high-risk spinal surgery.

BACKGROUND:

Surgical site infections (SSIs) after spinal fusion harm patients and are associated with significant health care costs. Given the high rate of SSI in neuromuscular populations, there is a rationale to develop infection prevention strategies.

METHODS:

An institutional clinical pathway was created in 2012 and based on nationally published Best Practice Guidelines as well as hospital practices with a goal of reducing the rate of deep SSI in high-risk patients. Patient and procedure characteristics were compared prior to (2008-2011) and after (2012-2016) implementation of the pathway. Logistic regression using penalized maximum likelihood was used to assess differences in rate of infection before and after implementation.

RESULTS:

Cohorts of 132 and 115 high-risk patients were analyzed before and after pathway implementation. Rate of deep infections decreased from 8% to 1% of patients (p = .005). Preoperative antibiotics were dosed within 1 hour in 90% of the postpathway cohort. Redosing was successful in 94% of patients for first redose and 79% for second redose. Betadine irrigation was used in 76% of cases and vancomycin administered in 86%. Multivariable analysis determined that instances of compliant antibiotics dosing had 63% lower odds of infection compared with instances of noncompliance (p = .04).

CONCLUSIONS:

Implementation of a multidisciplinary pathway aimed to reduce infection in patients at high risk for SSI after spinal fusion led to a significant reduction in deep SSI rate. It is impossible to attribute the drop in the deep SSI rate to any one factor. Our results demonstrate that adherence to a protocol using multiple strategies to reduce infection results in a lower SSI rate, lower care costs, and improved patient-related outcomes.

LEVEL OF EVIDENCE:

Level III.

KEYWORDS:

Infection protocol; Neuromuscular scoliosis; Scoliosis; Surgical site infection

PMID:
30587318
DOI:
10.1016/j.jspd.2018.06.010
[Indexed for MEDLINE]

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