Contributory factors to postoperative spinal fusion complications for children with myelomeningocele.

Abstract

This is a retrospective review of all children with myelomeningocele (MMC) who were undergoing surgery for scoliosis at our institution. Our aim was to investigate possible correlations between poor nutritional indexes and/or positive urinary cultures before surgery to perioperative infection risk. Patients who have scoliosis secondary to MMC have been shown to have a high rate of infectious complications. Many children with MMC have been found to have asymptomatic urinary tact infections due to their neurogenic bladder. There is little literature on risk factors for and ways to prevent postoperative infections for these patients. We reviewed a comprehensive database for the outcome for spinal fusion surgeries of 59 patients with MMC treated at our institution over the past 45 years. Perioperative infections were correlated to preoperative nutritional status (measured by patient hematocrit [Hct]) and presence of active infection using Fisher Exact Probability Test. A total of 84 different spinal fusion operations for 59 patients were recorded. Patients presenting with poor preoperative nutrition (Hct<or=33) and positive preoperative urinary cultures demonstrated the highest risk for perioperative wound infection (P=0.001). Patients with preoperative poor nutrition without a positive urinary culture as well as those with adequate nutritional status but a preoperative positive urinary culture showed an increased risk of wound infection respectively (P=0.03) and (P=0.002). Positive urine cultures obtained before spinal surgery for children with MMC significantly increased the risk for perioperative wound (P=0.002). Urinary tract infections can be easily detected and treated. We believe urinary culture, protein deficiencies, or Hct<or=33, should be treated and corrected before surgery.