{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T23:58:43Z","timestamp":1784937523130,"version":"3.55.0"},"reference-count":37,"publisher":"Cambridge University Press (CUP)","issue":"2","license":[{"start":{"date-parts":[[2015,1,2]],"date-time":"2015-01-02T00:00:00Z","timestamp":1420156800000},"content-version":"unspecified","delay-in-days":2161,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2009,2]]},"abstract":"<jats:sec id=\"S0195941700027648_abs1\"><jats:title>Objective.<\/jats:title><jats:p>To identify risk factors associated with surgical site infection (SSI) after pediatric posterior spinal fusion procedure by examining characteristics related to the patient, the surgical procedure, and tissue hypoxia.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700027648_abs2\"><jats:title>Design.<\/jats:title><jats:p>Retrospective case-control study nested in a hospital cohort study.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700027648_abs3\"><jats:title>Setting.<\/jats:title><jats:p>A 475-bed, tertiary care children's hospital.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700027648_abs4\"><jats:title>Methods.<\/jats:title><jats:p>All patients who underwent a spinal fusion procedure during the period from January 1995 through December 2006 were included. SSI cases were identified by means of prospective surveillance using National Nosocomial Infection Surveillance system definitions. Forty-four case patients who underwent a posterior spinal fusion procedure and developed an SSI were identified and evaluated. Each case patient was matched (on the basis of date of surgery, \u00b1 3 months) to 3 control patients who underwent a posterior spinal fusion procedure but did not develop an SSI. Risk factors for SSI were evaluated by univariate analysis and multivariable conditional logistic regression. Odds ratios (ORs), with 95% confidence intervals (CIs) and<jats:italic>P<\/jats:italic>values, were calculated.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700027648_abs5\"><jats:title>Results.<\/jats:title><jats:p>From 1995 to 2006, the mean annual rate of SSI after posterior spinal fusion procedure was 4.4% (range, 1.1%\u20146.7%). Significant risk factors associated with SSI in the univariate analysis included the following: a body mass index (BMI) greater than the 95th percentile (OR, 3.5 [95% CI, 1.5\u20138.3]); antibiotic prophylaxis with clindamycin, compared with other antibiotics (OR, 3.5 [95% CI, 1.2 10.0]); inappropriately low dose of antibiotic (OR, 2.6 [95% CI, 1.0\u20136.6]); and a longer duration of hypothermia (ie, a core body temperature of less than 35.5\u00b0C) during surgery (OR, 0.4 [95% CI, 0.2\u20130.9]). An American Society of Anesthesiologists (ASA) score of greater than 2, obesity (ie, a BMI greater than the 95th percentile), antibiotic prophylaxis with clindamycin, and hypothermia were statistically significant in the multivariable model.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700027648_abs6\"><jats:title>Conclusion.<\/jats:title><jats:p>An ASA score greater than 2, obesity, and antibiotic prophylaxis with clindamycin were independent risk factors for SSI. Hypothermia during surgery appears to provide protection against SSI in this patient population.<\/jats:p><\/jats:sec>","DOI":"10.1086\/593952","type":"journal-article","created":{"date-parts":[[2009,1,6]],"date-time":"2009-01-06T22:28:28Z","timestamp":1231280908000},"page":"109-116","source":"Crossref","is-referenced-by-count":128,"title":["Risk Factors Associated With Surgical Site Infection After Pediatric Posterior Spinal Fusion Procedure"],"prefix":"10.1017","volume":"30","author":[{"given":"W. Matthew","family":"Linam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Margolis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Allen","family":"Staat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria T.","family":"Britto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Hornung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Cassedy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverly L.","family":"Connelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2015,1,2]]},"reference":[{"key":"S0195941700027648_ref003","doi-asserted-by":"publisher","DOI":"10.1097\/01.QMH.0000281058.99929.ea"},{"key":"S0195941700027648_ref001","unstructured":"Centers for Disease Control and Prevention (CDC). Division of Healthcare Quality Promotion (DHQP). Estimates of Healthcare-Associated Infections. May 30, 2007. Available at: http:\/\/www.cdc.gov\/ncidod\/dhqp\/hai.html. Accessed March 14, 2008."},{"key":"S0195941700027648_ref012","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31814b1c0b"},{"key":"S0195941700027648_ref008","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000166532.58227.4f"},{"key":"S0195941700027648_ref007","doi-asserted-by":"publisher","DOI":"10.1086\/502259"},{"key":"S0195941700027648_ref035","doi-asserted-by":"publisher","DOI":"10.1038\/oby.2003.107"},{"key":"S0195941700027648_ref006","doi-asserted-by":"publisher","DOI":"10.1086\/512194"},{"key":"S0195941700027648_ref033","doi-asserted-by":"publisher","DOI":"10.1097\/00004647-200111000-00007"},{"key":"S0195941700027648_ref010","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.01515"},{"key":"S0195941700027648_ref024","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1997.01430330063010"},{"key":"S0195941700027648_ref013","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2004.10.001"},{"key":"S0195941700027648_ref018","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1542\/peds.101.S2.497","article-title":"Overweight children and adolescents: description, epidemiology, and demographics","volume":"101","author":"Troiano","year":"1998","journal-title":"Pediatrics"},{"key":"S0195941700027648_ref004","doi-asserted-by":"publisher","DOI":"10.1086\/502033"},{"key":"S0195941700027648_ref036","first-page":"1001","article-title":"Increased incidence of nosocomial infections in obese surgical patients","volume":"61","author":"Choban","year":"1995","journal-title":"Am Surg"},{"key":"S0195941700027648_ref009","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31815a5a86"},{"key":"S0195941700027648_ref014","first-page":"149","article-title":"Risk factors for surgical site infection in spinal surgery","volume":"98","author":"Olsen","year":"2003","journal-title":"J Neurosurg"},{"key":"S0195941700027648_ref031","doi-asserted-by":"publisher","DOI":"10.1152\/ajpcell.00507.2003"},{"key":"S0195941700027648_ref015","doi-asserted-by":"publisher","DOI":"10.1017\/S0195941700015241"},{"key":"S0195941700027648_ref028","first-page":"582","article-title":"Intraoperative hypothermia and postcesarean wound infection","volume":"91","author":"Munn","year":"1998","journal-title":"Obstet Gynecol"},{"key":"S0195941700027648_ref025","first-page":"876","article-title":"Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial (published correction appears in Lancet 2002;359:896)","volume":"358","author":"Meiling","year":"2001","journal-title":"Lancet"},{"key":"S0195941700027648_ref019","first-page":"27","article-title":"Antimicrobial prophylaxis for surgery","volume":"2","year":"2004","journal-title":"Treat Guidel Med Lett"},{"key":"S0195941700027648_ref029","doi-asserted-by":"publisher","DOI":"10.1007\/s007010050145"},{"key":"S0195941700027648_ref032","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1128\/CDLI.10.5.940-943.2003","article-title":"Effects of hypothermia on mortality and inflammatory responses to endotoxin-induced shock in rats","volume":"10","author":"Taniguchi","year":"2003","journal-title":"Clin Diagn Lab Immunol"},{"key":"S0195941700027648_ref020","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2005.01.015"},{"key":"S0195941700027648_ref022","doi-asserted-by":"publisher","DOI":"10.1177\/00034894921010S104"},{"key":"S0195941700027648_ref021","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2006.01.003"},{"key":"S0195941700027648_ref011","doi-asserted-by":"publisher","DOI":"10.1097\/01.bpo.0000206516.61706.6e"},{"key":"S0195941700027648_ref023","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000225438.86758.21"},{"key":"S0195941700027648_ref034","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(96)70306-9"},{"key":"S0195941700027648_ref005","doi-asserted-by":"publisher","DOI":"10.1086\/501572"},{"key":"S0195941700027648_ref002","doi-asserted-by":"publisher","DOI":"10.3201\/eid0902.020232"},{"key":"S0195941700027648_ref030","doi-asserted-by":"publisher","DOI":"10.1097\/00006454-200104000-00023"},{"key":"S0195941700027648_ref037","doi-asserted-by":"publisher","DOI":"10.1086\/502112"},{"key":"S0195941700027648_ref027","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1177\/000313489906500415","article-title":"Hypothermia does not result in more complications after colon surgery","volume":"65","author":"Barone","year":"1999","journal-title":"Am Surg"},{"key":"S0195941700027648_ref016","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-6553(99)70088-X"},{"key":"S0195941700027648_ref026","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199605093341901"},{"key":"S0195941700027648_ref017","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200404150-00023"}],"container-title":["Infection Control &amp; 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