Antonia Koch

Background Data: Pediatric patients undergoing surgery for secondary scoliosis are at special risk for surgical site infections (SSIs). The application of dexamethasone (Dexa) for perioperative prophylaxis of postoperative nausea and vomiting is an established method. Despite the benefits, there is still concern regarding an increased risk for SSI. Objective: This study aimed to evaluate the association between perioperative Dexa administration for PONV prophylaxis and the occurrence of SSI requiring surgical revision in pediatric patients undergoing surgery for secondary scoliosis. Study Design: Single-center retrospective cohort study. Methods: Patients younger than 18 years undergoing surgical treatment for secondary scoliosis between January 2017 and December 2021 were included. Demographic and surgical data were extracted from medical records and discharge summaries. SSI requiring surgical reintervention was the primary outcome. Statistical analysis was conducted using the Mann-Whitney U test, Fisher exact test, and Fisher-Freeman-Halton test, univariable and bivariable logistic regression. Results: One hundred sixty-two patients were included (Dexa: n=30, control: n=132). There were no significant differences considering demographics ( P >0.05). Patients receiving Dexa underwent undergoing revision surgery more often or had meningomyelocele (MMC). The overall incidence of infection was 11/162. Patients receiving Dexa showed a higher incidence of SSI requiring surgical reintervention (6/30 vs. 5/132, P =0.01) and were at higher Odds for SSI (OR: 5.25, 95% CI: 1.53–18.15, P =0.007), which remained significant after adjusting for confounders (MMC: OR: 3.97, 95% CI: 1.08–14.38, P =0.033; revision surgery: OR: 3.97, 95% CI: 1.08–14.38, P =0.033). Conclusions: This study observed an association between the preoperative application of Dexa for PONV prophylaxis in secondary scoliosis surgery and an increased risk of SSI. Our results give reason for a more thoughtful application of Dexa-based PONV prophylaxes in the perioperative therapy of a population of high-risk children for SSI with secondary scoliosis.

Introduction: Intrawound application of vancomycin is becoming increasingly controversial for the prevention of surgical site infection (SSI). As children undergoing spinal fusion for secondary scoliosis are at high risk for SSIs, evidence regarding the impact of intraoperative vancomycin installation on SSI rates in these patients is of utmost importance. Methodology: A single surgeon cohort of patients under 18 years of age undergoing surgery for secondary scoliosis in 2017 was analyzed with regard to the development of SSIs requiring surgical revision and adverse events. Use of vancomycin was restricted to cases with higher risk of infection. Patients undergoing distraction surgery for growing devices were excluded. Results: After exclusions, 64 patients remained (vancomycin n = 39, control n = 25). The SSI rates were 12.8% in patients receiving vancomycin (n = 5/39) and 4% in the control group (n = 1/25, p = 0.785). None of the patients suffered from adverse events. Univariable logistic regression revealed younger age (p = 0.03) and meningomyelocele as predictors for SSI (p = 0.006), while the high-risk group receiving vancomycin was not at higher odds for SSI, also after adjustment for possible confounders such as age or MMC (p = 0.031; p = 0.009). Discussion: SSI rates were comparable between groups, suggesting a normalization of SSI risk in the vancomycin-treated patients with a preoperatively increased risk of SSI. Future, larger studies in these rare diseases are needed to confirm these results.