Is There an Association Between Preoperative PONV Prophylaxis With Dexamethasone and Incidence of Wound Revisions in the Surgical Treatment of Pediatric Secondary Scoliosis? A Retrospective Cross-Sectional Study in 162 Patients

BACKGROUND DATA: Pediatric patients undergoing surgery for secondary scoliosis are at special risk for surgical site infections (SSIs). The application of dexamethasone (Dexa) for perioperative prophylaxis of postoperative nausea and vomiting is an established method. Despite the benefits, there is still concern regarding an increased risk for SSI. OBJECTIVE: This study aimed to evaluate the association between perioperative Dexa administration for PONV prophylaxis and the occurrence of SSI requiring surgical revision in pediatric patients undergoing surgery for secondary scoliosis. STUDY DESIGN: Single-center retrospective cohort study. METHODS: Patients younger than 18 years undergoing surgical treatment for secondary scoliosis between January 2017 and December 2021 were included. Demographic and surgical data were extracted from medical records and discharge summaries. SSI requiring surgical reintervention was the primary outcome. Statistical analysis was conducted using the Mann-Whitney U test, Fisher exact test, and Fisher-Freeman-Halton test, univariable and bivariable logistic regression. RESULTS: One hundred sixty-two patients were included (Dexa: n=30, control: n=132). There were no significant differences considering demographics (P>0.05). Patients receiving Dexa underwent undergoing revision surgery more often or had meningomyelocele (MMC). The overall incidence of infection was 11/162. Patients receiving Dexa showed a higher incidence of SSI requiring surgical reintervention (6/30 vs. 5/132, P=0.01) and were at higher Odds for SSI (OR: 5.25, 95% CI: 1.53-18.15, P=0.007), which remained significant after adjusting for confounders (MMC: OR: 3.97, 95% CI: 1.08-14.38, P=0.033; revision surgery: OR: 3.97, 95% CI: 1.08-14.38, P=0.033). CONCLUSIONS: This study observed an association between the preoperative application of Dexa for PONV prophylaxis in secondary scoliosis surgery and an increased risk of SSI. Our results give reason for a more thoughtful application of Dexa-based PONV prophylaxes in the perioperative therapy of a population of high-risk children for SSI with secondary scoliosis.