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Purpose <p>Surgical site infections (SSIs) remain a major complication after posterior spinal fusion for scoliosis. In 2019, our center implemented a peri-operative change combining pulsed lavage and closed-incision negative pressure therapy (cINPT). We compared SSI rates before versus after this protocol and explored outcomes.</p> Methods <p>We conducted a retrospective single-center cohort study including consecutive adolescents undergoing posterior fusion (2011–2025). Patients operated before 2019 received standard irrigation and a standard dressing; after 2019 they received pulsed lavage plus closed-incision negative pressure therapy (cINPT). The primary outcome was surgical site infection (SSI) within 90&#xa0;days of surgery, defined according to CDC/NHSN criteria (superficial incisional, deep incisional, or organ/space). Secondary outcomes included SSI timing (early ≤ 30&#xa0;days vs late (31–90&#xa0;days) and microbiology.</p> Results <p>The overall SSI rate was 11.0%, and it was higher in the neuromuscular subgroup than in idiopathic cases. SSI incidence decreased from 15.5% in the pre-2019 period to 5.7% after implementation of pulsed lavage plus cINPT. In multivariable modelling adjusted for pelvic extension, fusion length, and number of senior surgeons (but not operative time), the association persisted; when operative time was added, the association was attenuated and no longer statistically significant. Among infected cases, Staphylococcus aureus and Cutibacterium acnes were the most frequent pathogens, and most SSIs occurred within 30&#xa0;days.</p> Conclusion <p>In this single-center cohort, implementing&#xa0;pulsed lavage plus cINPT&#xa0;was associated with&#xa0;lower SSIs&#xa0;after posterior fusion for scoliosis, with a signal particularly relevant in&#xa0;neuromuscular&#xa0;patients. Although residual confounding cannot be excluded, these findings support integrating enhanced intra-operative irrigation and closed-incision therapy into multimodal SSI-prevention bundles.</p> Level of evidence <p>III (retrospective cohort).</p>

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Does the combination of pulsed lavage and negative pressure dressings reduce infection rates after posterior spinal arthrodesis in pediatric scoliosis ?

  • 期刊论文

  • 发表日期：

    2026年3月23日

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  • Simon Arvati,
  • Esther Hubert-Delisle,
  • Nolwenn Lemonnier,
  • Francesco Monti,
  • Isabelle Bernardini,
  • Mourad Ould Slimane,
  • Francois Luc

摘要

Purpose

Surgical site infections (SSIs) remain a major complication after posterior spinal fusion for scoliosis. In 2019, our center implemented a peri-operative change combining pulsed lavage and closed-incision negative pressure therapy (cINPT). We compared SSI rates before versus after this protocol and explored outcomes.

Methods

We conducted a retrospective single-center cohort study including consecutive adolescents undergoing posterior fusion (2011–2025). Patients operated before 2019 received standard irrigation and a standard dressing; after 2019 they received pulsed lavage plus closed-incision negative pressure therapy (cINPT). The primary outcome was surgical site infection (SSI) within 90 days of surgery, defined according to CDC/NHSN criteria (superficial incisional, deep incisional, or organ/space). Secondary outcomes included SSI timing (early ≤ 30 days vs late (31–90 days) and microbiology.

Results

The overall SSI rate was 11.0%, and it was higher in the neuromuscular subgroup than in idiopathic cases. SSI incidence decreased from 15.5% in the pre-2019 period to 5.7% after implementation of pulsed lavage plus cINPT. In multivariable modelling adjusted for pelvic extension, fusion length, and number of senior surgeons (but not operative time), the association persisted; when operative time was added, the association was attenuated and no longer statistically significant. Among infected cases, Staphylococcus aureus and Cutibacterium acnes were the most frequent pathogens, and most SSIs occurred within 30 days.

Conclusion

In this single-center cohort, implementing pulsed lavage plus cINPT was associated with lower SSIs after posterior fusion for scoliosis, with a signal particularly relevant in neuromuscular patients. Although residual confounding cannot be excluded, these findings support integrating enhanced intra-operative irrigation and closed-incision therapy into multimodal SSI-prevention bundles.

Level of evidence

III (retrospective cohort).