Vacuum sealing drainage as an adjunct to surgical debridement in pediatric acute hematogenous osteomyelitis: a retrospective cohort study.

Background: Acute hematogenous osteomyelitis (AHO) in children can lead to chronic infection if not adequately drained. Vacuum sealing drainage (VSD) is widely used in adult osteomyelitis, but evidence in children remains limited. Methods: This retrospective cohort study included 55 consecutive children with AHO treated surgically between November 2019 and May 2025. Twenty-five patients underwent debridement plus VSD (VSD group), and 30 underwent debridement alone (control group). Baseline demographics, clinical characteristics, laboratory findings, and surgical details were collected. The primary outcome was length of hospital stay; secondary outcomes included number of surgical procedures, intravenous antibiotic duration, and infection recurrence within 3 months. Inverse probability of treatment weighting (IPTW) was applied to address confounding. Results: Before adjustment, VSD was associated with significantly longer hospital stay (33.2 ± 19.3 vs. 21.0 ± 9.5 days, Conclusion: In children with AHO, adjunctive VSD therapy was associated with significantly longer hospitalization and more frequent surgical interventions compared with conventional debridement alone, without measurable improvements in infection control or recurrence. These findings do not support the routine use of VSD in uncomplicated pediatric AHO and highlight the need for individualized patient selection.