Plastic Multilayered Closure in Nonidiopathic Scoliosis Significantly Reduces the Risk of Wound Complications in a Pediatric Population
Thomas Imahiyerobo, Anas Minkara, James C. Lee, Fay Callejo, Hiroko Matsumoto, Benjamin Roye, David Roye, Michael Vitale.
Columbia University Medical Center, New York, NY, USA.
BACKGROUND: The purpose of this study was to compare the risk of surgical site infection (SSI) and wound complications between standard closure and plastic multilayered closure (PMC) in patients with nonidiopathic scoliosis undergoing primary or revision growth-friendly instrumentation or fusion.
METHODS: Patients with a diagnosis of nonidiopathic scoliosis undergoing primary or revision growth-friendly instrumentation or fusion for nonidiopathic scoliosis between 2014 to 2016 were included. Clinical charts and operative reports were reviewed. The SSI and wound complication risk of patients undergoing PMC was compared to standard closure. Additionally, the mean Risk Severity Score (RSS) for SSI, which utilizes patient characteristics to calculate the probability of SSI, was calculated to compare the observed (actual risk) and expected risk (RSS).
RESULTS: A total of 110 patients were identified (56 patients with standard closure and 54 patients with PMC were identified) with a mean age of 10.2 (55% female; mean preoperative coronal curve=58.5°). There was no statistically significant difference in age, preoperative major coronal curve, BMI, preoperative hemoglobin, estimated blood loss, mean RSS score, sex, race, etiology, and procedure type between the standard closure and PMC group (p>0.05). Following PMC implementation, the SSI rate decreased from 8.9% to 1.9%. The overall change in the observed (actual risk) vs. expected SSI risk (based on mean RSS score) indicated an overall decrease in SSI risk by 7.1%. The overall rate of wound complications decreased by 15.9% (3.7% vs 19.6% in standard closure), p=0.008. The mean increase in operative time due to PMC was 29 minutes.
CONCLUSIONS: Utilizing PMC in patients undergoing spinal surgery for nonidiopathic scoliosis significantly decreases the risk of wound complications and risk of SSI. Given the minimal increase in operative time required for this technique, surgeons should consider using PMC in high risk patients.
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