Authors: Meghan E Kramer; Stephen Gannon, BS; Alyssa Wiseman; Heidi Chen, PhD; Chevis Shannon, MBA, MPH, DrPH; Robert Naftel, MD (Memphis, TN)
Infection and readmissions following baclofen pump surgery are common and problematic. A standardized protocol was implemented at our institution for all baclofen pump surgeries aiming to reduce infection and readmission rates.
In September 2017, a standardized clinical protocol was implemented for all baclofen pump insertions and revisions. This protocol mandated a pre-operative alcohol preparation, 4% chlorhexidine scrub brush preparation, uniform antibiotic usage, as well as the use of an antibacterial envelope placed around all newly implanted and replacement pumps. Baclofen pump procedures from 2015-2018 were retrospectively reviewed for infection rate within 180 days and readmission rate within 90 days of the procedure. An odds ratio was calculated to investigate the association between protocol implementation and infection rates.
Of the 97 total baclofen pump procedures performed, 67 were pre-protocol and 30 were post-protocol. No differences were seen in patient sociodemographic data, surgery type, or total operative time between groups. Average patient age was 13 years at time of procedure. The overall protocol compliance rate was 100%. The 90-day readmission rate fell from 13% pre-protocol to 7% post-protocol. There was a decline in the 180-day infection rate from pre- and post-protocol periods (9% and 0%, respectively). Post-protocol patients were shown to have decreased odds of an infection within 180-days of surgery when compared to pre-protocol patients (OR 0.155, 95% CI 0.001 to 1.385).
To date, application of a standardized protocol has shown to aid in the reduction of infection and readmission rates following a baclofen pump surgery at our institution.