Reduction of Deep Infections and Length of Stay in Paediatric Spinal Deformity Surgery After the Introduction of A Standardised Care Pathway

Abstract

AIM: The purpose of the study was to investigate the impact of a new care pathway in reducing deep infections and length of stay following paediatric spinal deformity surgery in our institution.

METHOD: Restropective longitudinal cohort study of patients pre and post-institution of a new care protocol for paediatric patients undergoing scoliosis surgery were analysed. The new protocol introduced in 2010 involved all aspects of care pre, intra- and post operatively including patient, nurse and surgeon education with strict adherence to rules regarding wound care.

RESULTS: In total, 246 patients undergoing 275 procedures were studied. Between 2008-2009, 80 index procedures were performed, and between 2011-2012, 144 cases following the implementation of the pathway. There were no important demographic differences between the 2 cohorts. A significant reduction was seen in rates of infection from 37% to 2.9% for neuromuscular cases and 9.5% to 2.3% for idiopathic cases. An increased number of operations performed was also associated with a reduced mean hospital stay.

CONCLUSION: Deep infection rates following paediatric spinal deformity surgery carry major implications for morbidity. Complications including length of stay may be reduced with a team based approach to wound care.