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Title: Variability of surgical site infection with VEPTR at 8 centers: A retrospective cohort analysis

Authors: Garg S, Cyr M, St Hilaire T, Flynn T, Carry P, Glotzbecker M, Smith JT, Sawyer J, Pahys J, Luhmann S, Flynn JM, El-Hawary R, Vitale M

Journal: Spine Deform. 4(1):59-64

Date: January 01, 2016

Excerpt: This study reports infection rates and clinical characteristics for VEPTR procedures across 8 institutions.

Keywords: Complications, Early Onset Scoliosis, Growth Friendly Surgery, VEPTR, Infection

Summary:

What is the purpose of this study?

The goal of this paper is to analyze the clinical characteristics of children who have the VEPTR device implanted at different institutions and report infection rates.

 

RESULTS

  • 18% of VEPTR patients developed infection requiring operative debridement (55 infections in 38 patients out of 213 total patients). Between sites, this ranged from 2.9% to 42.9%.
  • There was no relationship found between primary C-EOS categories and infection rate. C-EOS categorized patients by congenital, syndromic, neuromuscular, and idiopathic.
  • Patients were much more likely to develop an infection following an implant procedure as compared to an expansion.
  • Reported symptoms of infection included wound drainage and dehiscence, fever, localized swelling, elevated laboratory values, and redness/warmth.

 

Important Discussion Points

  • Families should be aware of the high and variable infection rate associated with repetitive surgery, such as VEPTR treatment.
  • While the study found no relationship between C-EOS and infection rate, there is large variability in distribution of C-EOS and number of patients per site. To definitively determine whether a relationship exists, a much larger study is needed. Many other studies have shown larger infection rates with neuromuscular patients when compared to idiopathic patients.
  • While sites were not identified in this paper, they have agreed to be "unblinded" to share infection prevention protocols so that sites with higher infection rates can learn from sites with lower infection rates.