Multicenter evaluation of wound closure techniques and postoperative complications following pediatric nonidiopathic scoliosis surgery.

PURPOSE: To compare surgical site infection (SSI), reoperation, and readmission proportions following posterior spinal fusion (PSF) with pelvic instrumentation for pediatric nonidiopathic scoliosis between plastic multilayered closure (PMC) and standard orthopaedic closure (SOC).

METHODS

This study retrospectively reviewed patients ≤18 years with nonidiopathic scoliosis undergoing primary PSF with pelvic instrumentation at two institutions from 2018-2023. Exclusions were prior spinal fusion, staged procedures, and scoliosis associated with spina bifida, neoplasia, or congenital spondyloptosis. Outcome measures included SSI per CDC criteria, 90-day reoperation, and 30-day readmission. Patient risk was estimated with the NSQIP Pediatric Surgical Risk Calculator. Firth-penalized logistic regression modeled the association between closure technique and SSI.

RESULTS

Of 195 patients, 121 underwent SOC and 74 PMC. BMI was similar (p = 0.14), but SOC patients had higher mean surgical risk scores for any complication (p = 0.02) and SSI (p = 0.01). PMC had longer procedures, hospital stays, and greater drain use (all p < 0.001). SSI was lower with PMC (3% vs. 12%; absolute difference 9%, p = 0.03), whereas reoperation (5% vs. 13%, p = 0.08) and readmission (7% vs. 15%, p = 0.09) did not differ significantly. In multivariable analysis, PMC was associated with lower SSI odds (OR 0.12, 95% CI: 0.02-0.64, p = 0.01), and higher surgical risk scores were associated with increased SSI odds (OR 1.18, 95% CI: 1.04-1.33, p = 0.01).

CONCLUSION

PMC was associated with an absolute 9% lower SSI proportion. This association remained significant after adjustment for patient- and procedure-specific factors. Reoperation and readmission proportions were similar, but PMC involved longer surgical time, hospital stay, and greater drain use. Given these trade-offs, PMC may be most appropriate for high-risk patients or those with limited soft-tissue coverage. Prospective studies should refine patient selection and assess its broader impact.

LEVEL OF EVIDENCE: Level III-Therapeutic.