Building Consensus

• DOI: 10.1097/bpo.0b013e3182840de2
• Publication Date: 2013-06-08T11:59:42Z
• Authors: Michael G. Vitale; Matthew D. Riedel; Michael P. Glotzb...; Hiroko Matsumoto; David P. Roye; Behrooz A. Akbarnia; Richard C.E. Ande...; Douglas L. Brockm...; John B. Emans; Mark Erickson; John M. Flynn; Lawrence G. Lenke; Stephen J. Lewis; Scott J. Luhmann; Lisa M. McLeod; Peter O. Newton; Ann-Christine Nyq...; B. Stephens Richards; Suken A. Shah; David L. Skaggs; John T. Smith; Paul D. Sponseller; Daniel J. Sucato; Reinhard D. Zeller; Lisa Saiman
• Keywords: Delphi Method; Guideline; Expert opinion; Evidence-Based Medicine; Best practice

Perioperative surgical site infection (SSI) after pediatric spine fusion is a recognized complication with rates between 0.5% and 1.6% in adolescent idiopathic scoliosis up to 22% "high risk" patients. Significant variation the approach prophylaxis has been well documented. The purpose of this initiative develop consensus-based "Best Practice" Guideline (BPG), informed by both available evidence literature expert opinion, for high-risk patients undergoing fusion. For effort, high risk was defined as anything other than primary patient without significant comorbidities. ultimate goal decrease wide variability SSI prevention strategies area, ultimately leading improved outcomes reduced health care costs.An panel composed 20 surgeons 3 infectious disease specialists from North America, selected their extensive experience field surgery, developed. Using Delphi process iterative rounds using nominal group technique, participants were follows: (1) surveyed current practices; (2) presented detailed systematic review relevant literature; (3) given opportunity voice opinion collectively; (4) asked vote regarding preferences privately. Round 1 conducted an electronic survey. Initial results compiled discussed face-to-face. 2 Audience Response System, allowing (strongly support or support) against inclusion each intervention. Agreement >80% considered consensus. Interventions consensus revised, if feasible. Repeat voting performed.Consensus reached 14 all agreed implement BPG practices. All participate further studies assessing implementation effectiveness BPG. final driven surgery includes: should have chlorhexidine skin wash night before surgery; preoperative urine cultures obtained; receive Patient Education Sheet; nutritional assessment; (5) removing hair, clipping preferred shaving; (6) perioperative intravenous cefazolin; (7) gram-negative bacilli; (8) adherence antimicrobial regimens be monitored; (9) operating room access limited during (whenever practical); (10) UV lights need NOT used room; (11) intraoperative wound irrigation; (12) vancomycin powder bone graft and/or site; (13) impervious dressings are postoperatively; (14) postoperative dressing changes minimized discharge extent possible.In conclusion, we present consisting recommendations SSIs This can serve tool reduce practice area help guide research priorities future. Pending such data, it unsubstantiated authors paper that will not only but also result fewer children spinal fusion.Not applicable.