The variability in the management of acute surgical site infections: an opportunity for the development of a best practice guideline

Abstract

Background: Multiple studies have reported on the risks and preventative measures associated with acute surgical site infection (SSI) in patients with adolescent idiopathic scoliosis (AIS). Few studies have evaluated treatment and results. The purpose of this study was to evaluate the need for development of best practice guidelines based on the management of an acute SSI across 9 different centers.

Methods: A prospectively collected, multicenter database of patients undergoing surgical correction of AIS was reviewed for all acute SSI. Infection characteristics, treatment methods, and outcomes were summarized.

Results: Twenty-three (0.6%) from a total of 3926 AIS patients were treated for an acute SSI, all of which resolved. Twenty patients had documentation of the infection treatment (10 deep infections, 10 superficial). All ten patients with deep infections underwent operative incision and drainage. Six patients ultimately found to have a superficial infection underwent I&D and another 3 had dressing changes in the office. In the deep group, one patient had instrumentation exchanged and seven patients had bone graft removed. All 16 patients who underwent operative I&D had cultures obtained with 11 positive cultures. All deep infection patients were started on IV antibiotics for 2 days to 6 weeks prior to conversion to oral antibiotics. Five of six operative superficial infections were begun on IV antibiotics with conversion to oral antibiotics. Total antibiotic administration ranged from 5 days to 7 months in the deep infection group and 1 to 6 weeks in the superficial group.

Conclusions: While deep infections are consistently treated with I&D, there is significant variability in the surgical and medical management of acute SSI. Considering the universal resolution of the infection, there is opportunity for the development of BPG to minimize treatment morbidity and cost, while optimizing outcomes for this major complication.

Level of evidence: Therapeutic-IV.

Keywords: Adolescent idiopathic scoliosis; Best practice guidelines; Fusion; Infection; Surgical site infection.