Vacuum sealing drainage as an adjunct to surgical debridement in pediatric acute hematogenous osteomyelitis: a retrospective cohort study.

BACKGROUND

Acute hematogenous osteomyelitis (AHO) in children can lead to chronic infection if not adequately drained. Vacuum sealing drainage (VSD) is widely used in adult osteomyelitis, but evidence in children remains limited.

METHODS

This retrospective cohort study included 55 consecutive children with AHO treated surgically between November 2019 and May 2025. Twenty-five patients underwent debridement plus VSD (VSD group), and 30 underwent debridement alone (control group). Baseline demographics, clinical characteristics, laboratory findings, and surgical details were collected. The primary outcome was length of hospital stay; secondary outcomes included number of surgical procedures, intravenous antibiotic duration, and infection recurrence within 3 months. Inverse probability of treatment weighting (IPTW) was applied to address confounding.

RESULTS

Before adjustment, VSD was associated with significantly longer hospital stay (33.2 ± 19.3 vs. 21.0 ± 9.5 days, P = 0.003) and a greater number of surgical procedures (3.6 ± 1.5 vs. 1.0 ± 0, P < 0.001) compared with controls. No significant differences were observed in intravenous antibiotic duration (P = 0.51), superinfection rate (P = 0.45), or 3-month recurrence (0% in both groups). After IPTW, all covariates were well balanced (SMD < 0.1), and the effect estimates remained essentially unchanged: VSD remained associated with longer hospitalization (mean difference: 10.1 days; P = 0.009) and more procedures (mean difference: 2.5; P < 0.001). All patients achieved infection control without progression to chronic osteomyelitis.

CONCLUSION

In children with AHO, adjunctive VSD therapy was associated with significantly longer hospitalization and more frequent surgical interventions compared with conventional debridement alone, without measurable improvements in infection control or recurrence. These findings do not support the routine use of VSD in uncomplicated pediatric AHO and highlight the need for individualized patient selection.