New Cerebral Palsy Registry Data: Spine Fusion Infection Rates

It’s not the best news for children with cerebral palsy (CP) who have to undergo spinal fusion. When a group of researchers looked at multiyear, multicenter data, they found that infection rates have not declined as much as hoped. The study, “15 Years of Spinal Fusion Outcomes in Children with Cerebral Palsy: Are We Getting Better?” appears in the November 22, 2023, edition of Spine.

“We undertook the work now because it has been 15 years since the beginning of our registry of pediatric patients with cerebral palsy who had spinal fusion,” stated Paul Sponseller, M.D., chief of the Division of Pediatric Orthopaedics, Johns Hopkins Children’s Center, to OTW. “Quality improvements are timely topics. We undertook this study to see if the hoped-for improvements have really happened.”

As for why they studied this procedure in particular, Dr. Sponseller explained to OTW “Spinal fusion is a very high intensity intervention for these patients who have many medical comorbidities and challenges. We undertook this registry to see if we could quantify the outcomes and make improvements.”

Good news, noted Dr. Sponseller, was that “The operations have become faster with the use of improved instrumentation. The use of anti-fibrinolytic agents such as tranexamic acid and aminocaproic acid have made the big difference in blood loss.”

Furthermore, according to the latest data from the multicenter registry of pediatric CP patients who underwent spinal fusion from 2008 to 2020, the researchers found:

• A decline in mean estimated blood loss and transfusion volume
  • from 2.7±2.0 Liters in 2008 to 0.71±0.34 Liters in 2020 and
  • from 1.0±0.5 Liters in 2008 to 0.5±0.2 L in 2020, respectively, with a concomitant increase in antifibrinolytic use from 58% to 97%.
• A decline in unit rod and pelvic fusion use:
  • from 33% in 2008 to 0% in 2020 and
  • 96% in 2008 to 79% in 2020, respectively.
• A decline in mean postoperative intubation time:
  • from 2.5±2.6 days to 0.42±0.63 days,
• no changes in pre- and post-operative coronal angle and pelvic obliquity, operative time, frequency of anterior/anterior-posterior approach, and durations of hospital and intensive care unit stays.

The “Improvements in the Caregiver Priorities and Child Health Index of Life with Disabilities postoperatively” did not change significantly over the study period.

Complication rates, including reoperation, superficial and deep surgical site infection, and gastrointestinal and medical complications remained stable over the study period.

“Radiographic correction has always been excellent,” Dr. Sponseller told OTW. “Of the issues that remained constant, i.e., degree of radiographic correction, the rates of surgical and medical complications, and health-related quality-of-life measures, is there one that is able to be readily addressed (more than the others)?”

“The answer is ‘yes’. We wanted to try to improve on medical complications such as infection rates. That is stubbornly elevated, and that is the main finding of our article. Across a multicenter study, which is very representative of U.S. practice, infection rates have not meaningfully declined as much as we would like. We hope that this will spur researchers to identify more effective means to bring these down.”

Looking forward, said Dr. Sponseller to OTW, “We need improved infection prevention, perhaps starting with a change in the implant or implant coding or treatment.”