In the JournalsPerspective

Obese patients at greater risk for infection after adolescent idiopathic scoliosis correction

Patients who underwent posterior spinal fusion for the correction of adolescent idiopathic scoliosis and were obese had a greater risk for postoperative infection, according to results published in The Journal of Bone and Joint Surgery.

Peter O. Newton

Peter O. Newton, MD, and colleagues compared patients who presented with infection 90 days after posterior spinal fusion for the treatment of adolescent idiopathic scoliosis to a group of patients without an infection. Patients were compared with regard to age, gender, BMI percentile for age, Lenke classification of curve type, primary curve magnitude and estimated 3-D sagittal kyphosis.

Results showed 1% of 2,122 patients analyzed had an infection within 90 days after surgery. Patients with or without infection had significant differences in BMI percentile for age, according to results, with BMI percentile for age of 95% or greater being the only significant risk factor for infection using a binary logistic forward conditional model. Researchers found predicted infection rates based on the proportion of obese patients ranged from 0.8% to 1.2% for the eight sites that enrolled 100 or more patients. Researchers noted a more substantial variation in the range of the risk-adjusted infection rates, from 0.2% to 2%.

“In the case of this study, we have shown that infection rates after scoliosis surgery do vary amongst surgeons, but just as importantly, there is a patient factor (obesity) that must be accounted for when comparing surgeons’ performance regarding postoperative infection,” Newton told Healio.com/Orthopedics. “Adolescent idiopathic scoliosis is a fairly homogeneous patient population and even in this group, we find an important patient variable associated with an increased risk of infection that must be considered if one wishes to compare the performance of various providers.” – by Casey Tingle

 

Disclosures: Newton reports he received grants from Setting Scoliosis Straight Foundation, DePuy Synthes Spine, NIH, Orthopaedic Research and Education Foundation, Scoliosis Research Society and EOS imaging; received other funding from Setting Scoliosis Straight Foundation, Rady Children’s Specialists, Scoliosis Research Society, NuVasive, Electrocore, International Orthopedic Think Tank and Orthopediatrics Institutional Support; personal fees from DePuy Synthes Spine, the law firm of Carroll, Kelly, Trotter, Franzen & McKenna, the law firm of Smith, Haughey, Rice & Roegge, Thieme Publishers, Ethicon Endosurgery, Cubist and K2M; has a patent for anchoring systems and methods for correcting spinal deformities with royalties paid to DePuy Synthes Spine; a patent for low-profile spinal tethering systems issued to DePuy Spine Inc.; a patent for screw placement guide issues to DePuy Spine Inc.; and a patent for a compressor for use in minimally invasive surgery issued to DePuy Spine Inc. Please see the full study for a list of all other authors’ relevant financial disclosures.

Patients who underwent posterior spinal fusion for the correction of adolescent idiopathic scoliosis and were obese had a greater risk for postoperative infection, according to results published in The Journal of Bone and Joint Surgery.

Peter O. Newton

Peter O. Newton, MD, and colleagues compared patients who presented with infection 90 days after posterior spinal fusion for the treatment of adolescent idiopathic scoliosis to a group of patients without an infection. Patients were compared with regard to age, gender, BMI percentile for age, Lenke classification of curve type, primary curve magnitude and estimated 3-D sagittal kyphosis.

Results showed 1% of 2,122 patients analyzed had an infection within 90 days after surgery. Patients with or without infection had significant differences in BMI percentile for age, according to results, with BMI percentile for age of 95% or greater being the only significant risk factor for infection using a binary logistic forward conditional model. Researchers found predicted infection rates based on the proportion of obese patients ranged from 0.8% to 1.2% for the eight sites that enrolled 100 or more patients. Researchers noted a more substantial variation in the range of the risk-adjusted infection rates, from 0.2% to 2%.

“In the case of this study, we have shown that infection rates after scoliosis surgery do vary amongst surgeons, but just as importantly, there is a patient factor (obesity) that must be accounted for when comparing surgeons’ performance regarding postoperative infection,” Newton told Healio.com/Orthopedics. “Adolescent idiopathic scoliosis is a fairly homogeneous patient population and even in this group, we find an important patient variable associated with an increased risk of infection that must be considered if one wishes to compare the performance of various providers.” – by Casey Tingle

 

Disclosures: Newton reports he received grants from Setting Scoliosis Straight Foundation, DePuy Synthes Spine, NIH, Orthopaedic Research and Education Foundation, Scoliosis Research Society and EOS imaging; received other funding from Setting Scoliosis Straight Foundation, Rady Children’s Specialists, Scoliosis Research Society, NuVasive, Electrocore, International Orthopedic Think Tank and Orthopediatrics Institutional Support; personal fees from DePuy Synthes Spine, the law firm of Carroll, Kelly, Trotter, Franzen & McKenna, the law firm of Smith, Haughey, Rice & Roegge, Thieme Publishers, Ethicon Endosurgery, Cubist and K2M; has a patent for anchoring systems and methods for correcting spinal deformities with royalties paid to DePuy Synthes Spine; a patent for low-profile spinal tethering systems issued to DePuy Spine Inc.; a patent for screw placement guide issues to DePuy Spine Inc.; and a patent for a compressor for use in minimally invasive surgery issued to DePuy Spine Inc. Please see the full study for a list of all other authors’ relevant financial disclosures.

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    Perspective
    David L. Skaggs

    David L. Skaggs

    If “performance metrics,” such as surgical infections, are used to compare hospitals and doctors, and limit reimbursement from payers, we must have reliable data to adjust risk for patients more likely to have complications. Otherwise, there would be an incentive to withhold care to patients most likely to have complications or transfer them to other institutions.

    This study is one more striking example of how the epidemic of obesity in young Americans is hurting individuals and utilizing a disproportionate share of health care resources. Obese adolescents in this study were 7.7 times more likely to have surgical site infection than patients with a BMI percentile less than 95%.

    • David L. Skaggs, MD, MMM
    • Orthopedics Today Editorial Board Member Los Angeles

    Disclosures: Skaggs reports no relevant financial disclosures.