{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:11:49Z","timestamp":1792804309083,"version":"4.5.0"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Intrathecal baclofen (ITB) therapy is an effective treatment for spasticity and dystonia in children with cerebral palsy (CP). However, ITB pump surgery is associated with one of the highest rates of surgical site infection (SSI) in medicine, leading to significant morbidity and expense. Surgical protocols have reduced the rate of SSI in children with other CNS implants, and single-center protocols have been effective in ITB surgery in pediatrics. The authors describe the first multicenter quality improvement (QI)\u2013driven standardized protocol for ITB pump surgery in children with CP across the Cerebral Palsy Research Network (CPRN), implemented with the aim of reducing ITB-associated SSI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>SSI was defined as a culture-positive infection, ITB pump system removal for suspected infection, or wound dehiscence with exposed hardware. Each center reported historical infection rates for at least 3 years before initiating the SSI protocol (preintervention phase). After initiation of a 13-step surgical protocol, a consecutive series of 130 patients undergoing 149 surgical procedures for ITB at four CPRN tertiary pediatric neurosurgery centers were prospectively enrolled at surgery during a 2-year study period (intervention phase). QI methodology was used, including development of a key driver diagram and tracking performance using run and control charts. The primary process measure goal was documented compliance with 80% of the protocol steps, and the primary outcome measure goal was a 20% reduction in 90-day infection rate. Patient characteristics were collected from the CPRN Research Electronic Data Capture registry, including age at surgery, BMI, Gross Motor Function Classification System level, and pattern of spasticity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The aggregated preintervention 90-day ITB SSI rate was 4.9% (223 procedures) between 2014 and 2017. During the intervention phase, 136 of 149 ITB surgeries performed met inclusion criteria for analysis. The mean documented compliance rate with protocol steps was 75%, and the 90-day infection rate was 4.4%, with an average of 42 days from index surgery to infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This is the first multicenter QI initiative designed to reduce SSI in ITB surgery in children with CP. Ongoing enrollment and expansion of the protocol to other CPRN centers will facilitate identification of patient- and procedure-specific risk factors for SSI, and iterative plan-do-study-act cycles incorporating these data will further decrease the risk of SSI for ITB surgery in children.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2023.1.peds22368","type":"journal-article","created":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T11:05:47Z","timestamp":1677236747000},"page":"444-452","source":"Crossref","is-referenced-by-count":9,"title":["A multicenter initiative to reduce intrathecal baclofen pump surgical site infection: a Cerebral Palsy Research Network quality improvement project"],"prefix":"10.3171","volume":"31","author":[{"given":"Robert J.","family":"Bollo","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatric Neurosurgery, Primary Children\u2019s Hospital, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul H.","family":"Gross","sequence":"additional","affiliation":[{"name":"Cerebral Palsy Research Network, Greensville, South Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon G.","family":"Rocque","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatric Neurosurgery, Children\u2019s Hospital of Alabama, University of Alabama School of Medicine, Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel R.","family":"Browd","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatric Neurosurgery, Seattle Children\u2019s Hospital, University of Washington School of Medicine, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey S.","family":"Raskin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatric Neurosurgery, Riley Children\u2019s Hospital, University of Indiana School of Medicine, Indianapolis, Indiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey R.","family":"Leonard","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatric Neurosurgery, Nationwide Children\u2019s Hospital, The Ohio State College of Medicine, The Ohio State University, Columbus, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lama","family":"Albarqawi","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy F.","family":"Bailes","sequence":"additional","affiliation":[{"name":"Division of Occupational Therapy and Physical Therapy, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio; and"},{"name":"Department of Rehabilitation Exercise and Nutrition Sciences, University of Cincinnati School of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"_","family":"_","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","article-title":"What is cerebral palsy? Centers for Disease Control and Prevention. US Department of Health and Human Services. May 2, 2022","unstructured":"What is cerebral palsy? Centers for Disease Control and Prevention. US Department of Health and Human Services. May 2, 2022. Accessed January 24, 2023.https:\/\/www.cdc.gov\/ncbddd\/cp\/facts.html#:~:text=Cerebral%20palsy%20(CP)%20is%20a,problems%20with%20using%20the%20muscles"},{"issue":"11","key":"b2","series-title":"Cochrane Database Syst Rev","first-page":"CD004552","article-title":"Intrathecal baclofen for treating spasticity in children with cerebral palsy","volume":"2015","author":"Hasnat MJ","year":"2015","unstructured":"Hasnat MJ, Rice JE. Intrathecal baclofen for treating spasticity in children with cerebral palsy. Cochrane Database Syst Rev. 2015;2015(11):CD004552.26563961"},{"issue":"11","key":"b3","series-title":"JAMA","first-page":"1418","article-title":"Intrathecal baclofen for spasticity in cerebral palsy","volume":"265","author":"Albright AL","year":"1991","unstructured":"Albright AL, Cervi A, Singletary J. Intrathecal baclofen for spasticity in cerebral palsy. JAMA. 1991;265(11):1418\u20131422.1999883"},{"issue":"1","key":"b4","series-title":"J Pediatr Orthop","first-page":"76","article-title":"Complications of intrathecal baclofen pump therapy in pediatric patients","volume":"30","author":"Borowski A","year":"2010","unstructured":"Borowski A, Littleton AG, Borkhuu B,  Complications of intrathecal baclofen pump therapy in pediatric patients. J Pediatr Orthop. 2010;30(1):76\u201381.20032747"},{"issue":"4","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"395","article-title":"A standardized protocol to reduce pediatric baclofen pump infections: a quality improvement initiative","volume":"21","author":"Desai VR","year":"2018","unstructured":"Desai VR, Raskin JS, Mohan A,  A standardized protocol to reduce pediatric baclofen pump infections: a quality improvement initiative. J Neurosurg Pediatr. 2018;21(4):395\u2013400.29372853"},{"issue":"5","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"487","article-title":"Infections related to intrathecal baclofen therapy in children and adults: frequency and risk factors","volume":"4","author":"Fjelstad AB","year":"2009","unstructured":"Fjelstad AB, Hommelstad J, Sorteberg A. Infections related to intrathecal baclofen therapy in children and adults: frequency and risk factors. J Neurosurg Pediatr. 2009;4(5):487\u2013493.19877786"},{"issue":"1","key":"b7","series-title":"Pediatr Neurosurg","first-page":"1","article-title":"Complications of intrathecal baclofen pumps in children","volume":"39","author":"Gooch JL","year":"2003","unstructured":"Gooch JL, Oberg WA, Grams B, Ward LA, Walker ML. Complications of intrathecal baclofen pumps in children. Pediatr Neurosurg. 2003;39(1):1\u20136.12784068"},{"issue":"3","key":"b8","series-title":"Childs Nerv Syst","first-page":"421","article-title":"Intrathecal baclofen therapy: complication avoidance and management","volume":"27","author":"Haranhalli N","year":"2011","unstructured":"Haranhalli N, Anand D, Wisoff JH,  Intrathecal baclofen therapy: complication avoidance and management. Childs Nerv Syst. 2011;27(3):421\u2013427.20853002"},{"issue":"5","key":"b9","series-title":"J Child Orthop","first-page":"529","article-title":"Identification of complications in paediatric cerebral palsy treated with intrathecal baclofen pump: a descriptive analysis of 15 years at one institution","volume":"13","author":"Imerci A","year":"2019","unstructured":"Imerci A, Rogers KJ, Pargas C, Sees JP, Miller F. Identification of complications in paediatric cerebral palsy treated with intrathecal baclofen pump: a descriptive analysis of 15 years at one institution. J Child Orthop. 2019;13(5):529\u2013535."},{"issue":"10","key":"b10","series-title":"Dev Med Child Neurol","first-page":"1038","article-title":"Readmission and complications within 30 days after intrathecal baclofen pump placement","volume":"60","author":"Lam SK","year":"2018","unstructured":"Lam SK, Mayer RR, Vedantam A, A Staggers K, Harris DA, Pan IW. 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Adverse events associated with paediatric intrathecal baclofen in Australia: 5 years of data collection. J Paediatr Child Health. 2021;57(2):258\u2013262.32975337"},{"issue":"6","key":"b13","series-title":"J Neurosurg Pediatr","first-page":"756","article-title":"Risk factors for baclofen pump infection in children: a multivariate analysis","volume":"17","author":"Spader HS","year":"2016","unstructured":"Spader HS, Bollo RJ, Bowers CA, Riva-Cambrin J. Risk factors for baclofen pump infection in children: a multivariate analysis. J Neurosurg Pediatr. 2016;17(6):756\u2013762.26919315"},{"issue":"4","key":"b14","series-title":"J Neurosurg Pediatr","first-page":"391","article-title":"A new Hydrocephalus Clinical Research Network protocol to reduce cerebrospinal fluid shunt infection","volume":"17","author":"Kestle JR","year":"2016","unstructured":"Kestle JR, Holubkov R, Douglas Cochrane D,  A new Hydrocephalus Clinical Research Network protocol to reduce cerebrospinal fluid shunt infection. J Neurosurg Pediatr. 2016;17(4):391\u2013396.26684763"},{"issue":"1","key":"b15","series-title":"J Neurosurg Pediatr","first-page":"22","article-title":"A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative","volume":"8","author":"Kestle JR","year":"2011","unstructured":"Kestle JR, Riva-Cambrin J, Wellons JC III,  A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative. J Neurosurg Pediatr. 2011;8(1):22\u201329.21721884"},{"issue":"4","key":"b16","series-title":"J Am Med Inform Assoc","first-page":"602","article-title":"PEDSnet: a national pediatric learning health system","volume":"21","author":"Forrest CB","year":"2014","unstructured":"Forrest CB, Margolis PA, Bailey LC,  PEDSnet: a national pediatric learning health system. J Am Med Inform Assoc. 2014;21(4):602\u2013606.24821737"},{"issue":"2","key":"b17","series-title":"J Pediatr Rehabil Med","first-page":"161","article-title":"The Cerebral Palsy Research Network: building a learning health network for cerebral palsy","volume":"14","author":"Bailes AF","year":"2021","unstructured":"Bailes AF, Kean J, Gross PH,  The Cerebral Palsy Research Network: building a learning health network for cerebral palsy. J Pediatr Rehabil Med. 2021;14(2):161\u2013171."},{"key":"b18","series-title":"Joffrey-Bass;","article-title":"The Improvement Guide: A Practical Approach to Enhancing Organizational Performance","author":"Langley G","year":"2009","unstructured":"Langley G, Nolan K, Nolan T,  The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd ed. Joffrey-Bass; 2009."},{"issue":"4","key":"b19","series-title":"BMJ Qual Saf","first-page":"290","article-title":"Systematic review of the application of the plan-do-study-act method to improve quality in healthcare","volume":"23","author":"Taylor MJ","year":"2014","unstructured":"Taylor MJ, McNicholas C, Nicolay C, Darzi A, Bell D, Reed JE. Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Qual Saf. 2014;23(4):290\u2013298.24025320"},{"issue":"6","key":"b20","series-title":"Qual Saf Health Care","first-page":"458","article-title":"Statistical process control as a tool for research and healthcare improvement","volume":"12","author":"Benneyan JC","year":"2003","unstructured":"Benneyan JC, Lloyd RC, Plsek PE. Statistical process control as a tool for research and healthcare improvement. Qual Saf Health Care. 2003;12(6):458\u2013464.14645763"},{"key":"b21","series-title":"Learning from Data for Improvement. Jossey-Bass;","article-title":"The Heath Care Data Guide,","author":"Provost L","year":"2011","unstructured":"Provost L, Murray S. The Heath Care Data Guide,. Learning from Data for Improvement. Jossey-Bass; 2011."},{"issue":"5","key":"b22","series-title":"N Engl J Med","first-page":"491","article-title":"A surgical safety checklist to reduce morbidity and mortality in a global population","volume":"360","author":"Haynes AB","year":"2009","unstructured":"Haynes AB, Weiser TG, Berry WR,  A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491\u2013499."},{"issue":"3","key":"b23","series-title":"J Neurosurg Pediatr","first-page":"259","article-title":"A standardized protocol to reduce pediatric spine surgery infection: a quality improvement initiative","volume":"14","author":"Ryan SL","year":"2014","unstructured":"Ryan SL, Sen A, Staggers K, Luerssen TG, Jea A. 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