Impact of a Multidisciplinary Approach on Surgical Site Infections (SSIs) in Pediatric Posterior Spine Fusions (PSF): Insights From a Ten-Year Cohort Study (2012-2022).

Abstract

Surgical site infections (SSIs) after pediatric posterior spine fusion (PSF) remain a notable concern. Our institution launched the Target Zero (TZ) initiative in 2007 to reduce SSIs through standardized prevention protocols. This study evaluates SSI rates from 2012 to 2022, following the initiative's early years (2006 to 2012). After IRB approval, we conducted a retrospective review of 1476 PSF patients aged 10 to 18 from July 2012 to December 2022. Patients were stratified into high-risk (HR) and low-risk (LR) groups based on comorbidities. Infection rates and associated factors were analyzed. Of 1476 patients, 495 were HR and 981 LR. SSI rates were significantly higher in HR patients than in LR patients (6.87% vs 0.92%, P < 0.001). The number of levels fused and estimated blood loss did not differ significantly between cohorts with and without infection. HR patients who developed an SSI had longer procedures (302.4 vs 252.5 minutes; P < 0.03). Time of procedure was not significantly different in LR patients with or without infection. Compliance with TZ antibiotic protocols was high (100% LR, 98% HR). Compared with the previous cohort (2008 to 2012), SSI rates in LR patients declined from 2.7% (2008 to 2012) to 0.92% (2012 to 2022), while rates in HR patients remained stable (6.87% vs 6.5%). Protocol compliance improved from 85% to 98%. SSI rates in LR patients have declined over the past decade, reflecting sustained effectiveness of TZ protocols. Rates in HR patients remained unchanged, highlighting the need for targeted strategies for high-risk populations. These findings are consistent with known risk factors of SSIs in pediatric spine fusion surgery.