Wound infections after surgery for neuromuscular scoliosis: risk factors and treatment outcomes.

Study Design: Retrospective, case-control study.

Objective: Determine risk factors for postoperative wound infections after surgery for neuromuscular scoliosis as well as the causative organisms and the results of treatment.

Summary Of Background Data: Wound infection after surgery for neuromuscular scoliosis is more common than that for idiopathic scoliosis. A variety of potential risk factors have been identified, but few have demonstrated statistical significance.

Methods: The Pediatric Orthopedic Spine Database identified 151 patients with neuromuscular scoliosis who underwent surgery and had a follow-up of minimum of 2 years. A total of eight patients (5.3% prevalence) developed a postoperative wound infection. Nine patients without an infection were matched by year and type of surgery, for each patient with an infection and selected as controls (n = 72). Preoperative, intraoperative, and postoperative factors were analyzed for an association with wound infection by using stepwise logistic regression. In addition, causative organisms as well as the methods and results of treatment were recorded for each patient. RESULTS.: The control group consisted of 32 males and 40 females with a mean age of 13.3 years (range, 7-21 years) and a mean follow-up of 4.6 years (range, 2.0-20.9 years) at surgery. The infection group (n = 8) consisted of four males and four females with a mean age of 12.5 years (range, 11-14 years) and a mean follow-up of 5.1 year (range, 2.0-12.3 years) at surgery. There were five early and three late wound infections. The presence of a ventriculoperitoneal shunt before surgery was the only factor statistically associated with an increased risk for wound infection (P < 0.01). In addition, infection was associated with pseudarthrosis (P < 0.01) and an increased length of hospitalization (P < 0.01). The most common causative species was staphylococcus and the majority (88%) of infections required surgical intervention with a mean of 2.1 debridements (range, 1-4 debridements).

Conclusions: The presence of a ventriculoperitoneal shunt is a statistically significant risk factor for wound infection after corrective surgery for neuromuscular scoliosis. Wound infection is associated with pseudarthrosis and prolonged hospitalization.

Level Of Evidence: III.