Abstract
ABSTRACT Objective: To identify the cost effectiveness of vancomycin powder in the prophylaxis of posterior lumbar spine instrumentation, seeking potential savings. Methods: A retrospective, observational study was performed to evaluate the cost effectiveness. Data were retrieved from patients’ files from March 2016 to April 2017; costs were considered for the procedures, as well as which antibiotic was used. Results: A total of 184 patients were included. Of these, 102 received prophylactic treatment with 1g of cephalothin and 82 received 1g of cephalothin and 1g of vancomycin powder, which was applied to the wound prior to tissue closure. Of the 184 patients, 110 were women (59%) and 74 were men (41%), and the mean age was 55 years (24-77). The participants had a median BMI of 28.9 kg/m2 (19-39). The average cost per hospitalized patient was $3974 USD and the average cost of rehospitalization due to infection was, on average, $7700 USD. The use of vancomycin powder led to cost savings of $75,008.79 USD per 100 posterior spinal fusions performed for degenerative spine. Conclusion: The use of vancomycin powder is a cost-effective option for prophylaxis of surgical site infection in spine fusion. Level of evidence III; Economic and decision analysis.
Highlights
The patients received Cephalothin 30 minutes prior to the surgical incision, plus a booster dose and two further postsurgical doses, with their respective reinforcement doses according to time and surgical bleeding, as they set up antibiotic prophylaxis guidelines
Our results demonstrate that the use of local vancomycin powder led to a significant reduction in the rate of surgical site infection, from 9.8% in the control group to 2.4% in the treatment group
Similar to the results reported by Murphy et al.14 we Patients with surgical site infection encountered no negative side effects, which is consistent with the low incidence reported by Ghobrial et al.,15 and we consider it safe to use, with caution, monitoring for the rare side effects reported by Ghobrial
Summary
Surgical site infection (SSI) is one of the most common and potentially devastating complications in spine surgery. Its incidence varies depending on various factors, and it is estimated that between 2.8% and 11.9% of patients undergoing spinal surgery will suffer SSI, despite the application of conventional prophylactic strategies.3Deep spinal infection is associated with higher costs of morbidity, mortality and health care, at an estimated cost of between 1 and 10 trillion dollars annually. The treatment of SSI involves considerable costs, due to prolonged hospitalization time, the use of diagnostic methods, interventions and treatment with intravenous antibiotics, among other things.4,5Surgeons should make a great effort to minimize the risk factors for wound infection after spine surgery. Reported risk factors for increased rates of deep infection include advanced patient age, obesity, malnutrition, prolonged surgical time, surgery review, increased blood loss, smoking, use of instrumentation, and revision surgery.. Surgical site infection (SSI) is one of the most common and potentially devastating complications in spine surgery.. Its incidence varies depending on various factors, and it is estimated that between 2.8% and 11.9% of patients undergoing spinal surgery will suffer SSI, despite the application of conventional prophylactic strategies.. Deep spinal infection is associated with higher costs of morbidity, mortality and health care, at an estimated cost of between 1 and 10 trillion dollars annually.. Surgeons should make a great effort to minimize the risk factors for wound infection after spine surgery.. Reported risk factors for increased rates of deep infection include advanced patient age, obesity, malnutrition, prolonged surgical time, surgery review, increased blood loss, smoking, use of instrumentation, and revision surgery.
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