Journal of Pediatric Orthopaedics - 2026-01-01 - Journal Article
Sealing the Deal: Incisional Vacuum Assisted Closure Following Neuromuscular Posterior Spinal Fusion is Associated With a Lower Rate of Infection.
Regan MD, Freeman CM, Talathi N, Spiegel DA, Flynn JM, Baldwin KD
Topics
Key Takeaway
Incisional VAC following neuromuscular posterior spinal fusion reduced unplanned return to OR for infection from 21.0% to 7.3% (2.9x reduction, NNT=7.3, p=0.023), with patients discharged home with iVAC having only a 2.2% infection rate.
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Summary
This single-institution retrospective cohort evaluated whether iVAC placement at index PSF reduces SSI-related unplanned return to OR within 90 days in nonambulatory pediatric neuromuscular scoliosis patients. Of 134 patients, 96 received iVAC and 38 did not, with a consistent institutional SSI prevention protocol applied to both groups. UPROR for infection was 7.3% with iVAC versus 21.0% without (p=0.023), and patients discharged home with iVAC had the lowest infection rate at 2.2%.
Key Limitation
Non-randomized allocation without controlling for key infection risk factors (nutritional status, seizure disorder, urinary incontinence, prior SSI, curve magnitude, operative time) means the iVAC and control groups may not be comparable, and the observed benefit could reflect surgeon selection bias toward lower-risk patients receiving iVAC.
Original Abstract
BACKGROUND
Surgical site infection (SSI) after posterior spinal fusion (PSF) to correct neuromuscular scoliosis is a devastating complication in pediatric patients. Incisional Vacuum-Assisted Closure (iVAC) is a method used for wound management, especially in high-risk surgical wounds. Pediatric neuromuscular patients are at high risk for infection or wound complications following spinal deformity correction. The goal of this study was to evaluate the effectiveness of iVAC therapy after PSF in pediatric neuromuscular scoliosis in preventing wound dehiscence and SSI as measured by the metric of unplanned return to the OR for infection in <90 days from the date of surgery.
METHODS
We reviewed all nonambulatory patients with neuromuscular scoliosis who underwent PSF at a single, large tertiary care pediatric hospital from 2019 to 2024. Ambulatory patients with neuromuscular disease were excluded. During this period of time, a consistent SSI prevention protocol was active and remained similar for all spine surgeons at our institution. Patients were placed into 1 of 2 groups based on whether they had an iVAC placed at the index procedure, and postoperative outcomes were examined.
RESULTS
A total of 134 patients [71 (53%) male and 63 (47%) female] with a mean age of 13.5±3.1 years at the time of surgery were included. Unplanned return to the operating room (UPROR) for suspected infection (<90 d) occurred among 7 (7.3%) patients with iVAC versus 8 (21.0%) without. UPROR was 2.9 times higher without iVAC ( P =0.023). Only one (2.2%) patient faced infection among those sent home with the iVAC [ P =0.020 (vs. either iVAC in the hospital or no iVAC)]. The number needed to treat with iVAC treatment to prevent one UPROR was 7.3.
CONCLUSION
iVAC is a clinically useful, low-cost, low-morbidity tool in the fight against NM infection. Any duration of use of the iVAC following neuromuscular PSF appears to be associated with a lower incidence of infection.
LEVEL OF EVIDENCE
Level III.