Risk Factors for Surgical Site Infection in Neuromuscular Scoliosis Surgery

Abstract

Introduction: Although spinal fusion surgery is beneficial for treating neuromuscular scoliosis (NMS), a high rate of complications remains problematic, and surgical site infection (SSI) is one of the most common and undesirable complications. In this study, we aimed to investigate the risk factors for SSI in NMS surgery, given that several known risk factors, such as gastrotomy, tracheostomy, and low body weight, are frequently present in our clinical cases.

Methods: We retrospectively analyzed 129 cases of posterior spinal fusion surgery for NMS patients between March 2017 and March 2022. The median age at surgery was 14.3 years, and BMI was 14.2 kg/m². The preoperative main Cobb angle was 92 degrees, and the Spino-pelvic obliquity (SPO) was 22 degrees. Ninety-three patients had epilepsy, and 45 patients had gastrotomy. We compared preoperative and perioperative patient data between the SSI and non-SSI groups.

Results: Five cases developed SSI. In comparing the SSI and non-SSI groups, we found statistically significant differences in SPO, anesthesia induction time, pelvic fixation, and the use of the V-flap technique for SSI. We did not find a clear association between SSI and epilepsy, gastrotomy, tracheostomy, GMFCS, low BMI, severity of preoperative deformity, intraoperative blood loss, surgical time, intraoperative hypothermia, or correction rate of deformity.

Conclusion: Our study revealed that there is still an SSI risk in NMS patients requiring pelvic fixation. Furthermore, patients who require a prolonged induction of anesthesia are suggested to be at further risk for SSI. These findings may help to guide the selection of patients for surgery and perioperative management to minimize SSI.