Étude rétrospective des infections postopératoires et leurs facteurs de risque lors de chirurgie de scoliose en pédiatrie au CHU de Bordeaux

Abstract : Background: perioperative management of scoliosis in paediatrics is complex, requires a multidisciplinary team, and involves a high morbidity-mortality rate. The most frequent complications are infections, with a prevalence rate from 1 % to 10 % depending on model. We need to know the incidence rate of complications, especially postoperative-acquired infections, their bacterial ecology, and the associated risk factors, in order to optimize management of those patients. Objective: assess the incidence rate, bacterial ecology and risk factors linked to healthcare associated infections in a 3-month postoperative period following scoliosis surgery in the paediatric surgery department of the Universitary Hospital in Bordeaux. Methods: we led a retrospective, observational, descriptive, monocentric study. Every patient who underwent a paediatric scoliosis surgery in the Children Hospital of Bordeaux in 2016 ans 2017 were included. Patient characteristics, postoperative complications and perioperative variables were taken from their computerized medical files. Univariate analysis was used to determine the variables associated with postoperative healthcare associated infections at all sites, surgical site infections and infections with multiresistant bacteria. Multivariate analysis was used to determine the factors linked to postoperative healthcare associated infections at all site and surgical site infections. Results: 108 patients were included, 44 % of which were idiopathic scoliosis and 40 % of neuromuscular origin. The main postoperative complications were unexpected surgical revisions (35/108 patients representing 32%), surgical site infections (20/108 patients representing 28%) and neurological complications (17/108 patients representing 16%). Incidence rate of infections with multiresistant bacteria was 14 %. In univariate analysis, associated factors with postoperative healthcare associated infections on all sites were mental retardation (OR=2,5 [1-6] ; p=0,05), more than 10 vertebrae operated on (OR=5,5 [1,4 – 22,1] ; p=0,02), peroperative breaches (OR=11,9 [1,8 – 79,2] ; p=0,008] and ASA score >2 (OR=3 [1,3 – 7,2] ; p=0,01). Associated factors with surgical site infections were preoperative anemia (OR=3,2 [1-10] ; p=0,05), more than 10-vertebrae arthrodesis (OR=6,7 [1,2 – 38,2] ; p=0,004) and perioperative breaches (OR=15,2 [2,1 – 110] ; p=0,003). Associated factors to multiresistant bacteria infections were psychomotor retardation (OR=4 [1,3-12] ; p=0,03) and extended prophylactic antibiotic treatment (OR=3,3 [1-10,6] ; p=0,05). In multivariate analysis, perioperative breaches increased risk of healthcare associed infections at all sites (OR=7,9 [1,2 – 51,4] ; p=0,03) and of surgical site infections (OR=7,6 [1,2 – 48,9] ; p=0,03). Conclusions: the incidence rate of postoperative septic complications of pediatric scoliosis surgery in Bordeaux Children Hospital is associated not only with already known risk factors as the number of vertebrae operated on, but also previously unknown risk factors as peroperative meningeal breaches. Optimizing the medical and surgical management of the perioperative period is necessary in order to decrease morbidity-mortality rates.
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Master Thesis
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Quentin Hisz. Étude rétrospective des infections postopératoires et leurs facteurs de risque lors de chirurgie de scoliose en pédiatrie au CHU de Bordeaux. Médecine humaine et pathologie. 2018. ⟨dumas-02089989⟩

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