Surgical site infection in adolescent idiopathic scoliosis surgery

Objective: To define the current rate of postoperative surgical site infections (SSIs) in a large prospective series of surgical adolescent idiopathic scoliosis (AIS) cases. Methods: A multicenter, prospective database of patients who underwent surgical correction of AIS was reviewed. Early SSIs were defined as occurring within 90 days after the index operation, as per the Center for Disease Control's definitions. Treatment and outcome information on all confirmed SSIs was compiled. Variables associated with the occurrence of an SSI were evaluated. Results: Of the 1,757 patients analyzed, 28 developed an SSI within the first 90 days postoperatively (1.6%). Patient weight was associated with SSI (p <.001). There was a trend in correlation with the number of levels fused (p =.07) and blood loss as a percentage of blood volume (p =.07) and the incidence of SSI. There was no correlation with any other variables. There was variation in the rate of SSI among the 9 centers, ranging from 0.6% to 4.4% (p =.27). Of the 28 infections, 26 resolved with surgery and/or antibiotics and did not need implant removal. Only 2 patients had late pain. In addition to the 28 confirmed SSIs, there were an additional 68 other wound issues (4.2%) that did not meet the Center for Disease Control criteria for an SSI. Conclusions: Early SSIs after AIS surgery occurred at a rate of 1.6%. The federal mandate to eliminate SSI and the proposed lack of reimbursement for its treatment may change clinical practice, and these data provide average SSI rates across multiple centers for future comparison. Investigations into variations in practice between centers might yield areas for potential improvement in SSI for AIS patients. Fortunately, 92% of patients were able to retain their implants and were free of pain at final follow-up.