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Matt Oetgen and patient

Periop procedures improve scoliosis surgery infection rates

Matt Oetgen and patient

Matthew Oetgen, M.D., MBA, chief of orthopaedics and sports medicine at Children’s National Hospital, presented findings from a study aimed at improving quality and safety for pediatric spinal fusion procedures by reducing surgical site infection rates.

Pediatric orthopaedic surgery as a field is focused on improving quality and value in pediatric spine surgery, especially when it comes to eliminating surgical site infections (SSI). Many studies have documented how and why surgical site infections occur in pediatric spinal fusion patients, however, there is very little data about what approaches are most effective at reducing SSIs for these patients in a sustainable way.

At the Pediatric Orthopaedic Society of North America’s 2020 Annual Meeting, Matthew Oetgen, M.D., MBA, chief of orthopaedic surgery and sports medicine at Children’s National Hospital, presented findings from a long-term single institution study of acute SSI prevention measures.

“These findings give us specific insight into the tactics that are truly preventing, and in our case sometimes even eliminating, SSIs for pediatric scoliosis surgery,” says Dr. Oetgen, who also served on the annual meeting program committee. “By analyzing patient records across more than a decade, we were able to see that some strategies are quite effective, and others, that we thought would move the needle, just don’t.”

The team reviewed medical records and radiographs dating back to 2008 for 1,195 patients who had spinal fusion for scoliosis, including idiopathic scoliosis as well as other forms such as neuromuscular or syndromic scoliosis. Over that period of time, the division of orthopaedics and sports medicine at Children’s National was collaborating with the hospital’s infection control team to achieve several programmatic implementation milestones, including:

  • January 2012: Standardized infection surveillance program
  • July 2013: Standardized perioperative infection control protocols including those for pre-operative surgical site wash, surgical site preparation and administration of antibiotics before and after surgery
  • March 2015: Standardized comprehensive spinal care pathway including protocols for patient temperature control, fluid and blood management, and drain and catheter management

Over the study time period, the team found that SSIs did decrease, but interestingly, the rate did not progressively decrease with each subsequent intervention.

“Instead, we found that the rate went down and was even eliminated for some subgroups when the perioperative infection control protocols were implemented in 2013 and sustained through the study period end,” says Dr. Oetgen. “The other programmatic efforts that started in 2012 and 2015 had no impact on infection rates.”

He also notes that the study’s findings have identified a crucial component in the process for infection control in pediatric spinal surgery—perioperative protocols. “A relatively uncomplicated perioperative infection control protocol did the best job decreasing SSI in spinal fusion. Future efforts to optimize this particular protocol may help improve the rates even further.”

POSNA’s Annual Meeting content, including Dr. Oetgen’s presentation, is available from May 13, 2020 through December 31, 2020.

Dr. Benjamin Martin examines a patient

Understanding Legg-Calvé-Perthes disease

Dr. Benjamin Martin examines a patient

Legg-Calvé-Perthes disease, which affects between five and 10 of every 100,000 children each year, is so rare that it can sometimes be challenging for clinicians to know how best to care for affected patients.

That’s why in 2011 a group of pediatric orthopaedic specialists led by Texas Scottish Rite Children’s Hospital created an international study group dedicated to using research to improve the care of kids with Perthes, a hip disorder characterized by a loss of blood flow to the immature femoral head. Children’s National orthopaedic surgeon Benjamin Martin, M.D., has participated in the group since its launch.

Recently, Dr. Martin and two study group colleagues published a review study that outlines common imaging modalities used in the diagnosis and treatment of Perthes disease.

“There are many imaging options out there, including recent advances in MRI, that can add to our knowledge of the disease and how to treat it so kids have optimal outcomes,” Dr. Martin says. “Our goal was to review what’s out there, how it’s used, and identify any shortcomings of these approaches for this particular patient population.”

The authors note that imaging, in various forms, has been a crucial contributor to understanding and treatment of this disease since it was first discovered. Today, radiography remains the most common imaging technique used to diagnose and follow Perthes over time. However, some MRI applications may offer additional insight into the disorder.

Perfusion MRI allows for early understanding of extent of disease and perfusion patterns may correlate with outcomes. Diffusion weighted imaging (DWI) MRI is another promising avenue for tracking disease progression. Additionally, dynamic MRI might provide range of motion assessments that could be used in the surgical planning process.

This study was one of a handful that the international Perthes group has published so far, with several more currently under development. Exploring treatments and technology applications will enhance early diagnosis and treatment for Perthes, which is a crucial component of treatment success and improved quality of life for affected children.