Intrawound Vancomycin Research Articles

Intra-wound Vancomycin Reduces the Infection in Growth-Friendly Spine Surgery

Introduction Patients with Early Onset Scoliosis (EOS) who require growth-friendly spine surgery are known to be at high risk for infections and/or wound dehiscence. Several studies in pediatric and adult patients undergoing spine surgery have shown that vancomycin powder applied to the wound before closure significantly reduces the risk of post-operative infection. There are currently no studies that evaluate the efficacy of intra-wound vancomycin in reducing infection for patients undergoing growth-friendly spine surgery. Methods Data from 116 patients in a prospectively collected database with EOS of multiple diagnoses were reviewed. Patients were divided into two groups. From May 2002 through June 2013, there were 1036 VEPTR procedures in which no patient received intra-wound vancomycin. Beginning in June 2013, there were 161 consecutive EOS procedures having VEPTR surgery and all had intra-wound vancomycin powder. Patient groups were compared based on age, gender, diagnosis, type of surgery, ambulatory status, and bowel/bladder incontinence. Additionally, complications related to intra-wound vancomycin powder were reviewed. Results The pre- and post-vancomycin groups were similar with regard to age, gender, diagnosis, ambulatory status, and bowel/bladder incontinence. The groups were significantly different with regard to type of surgery (Table 1). Prior to the use of intra-wound vancomycin, the infection rate in VEPTR surgery was 5.7%. The patients receiving intra-wound vancomycin had a significantly reduced infection rate of 1.2%. ( p < 0.031). Using multivariate logistic generalized estimating equation model to control for surgery type, infection rate was lower in the patients who received intra-wound vancomycin as compared with the patients who did not receive intra-wound vancomycin (1.2% versus 4.4%, p = 0.066). There were no complications related to the administration of intra-wound vancomycin. Conclusion Intra-wound vancomycin is safe and reduces infection rates for patients undergoing growth-friendly spine surgery.

The Role of Vancomycin Powder to Prevent Wound Infection in Spine Surgery: Protocol of Randomized Control Trail

Introuduction Postoperative surgical site infection (SSI) continues to be an important problem after orthopedic procedures, especially spine surgery. Reported incidences of surgical-site infection among patients who undergo spine surgery range from 2% to 6% and > 10% after instrumented fusions. Postoperative surgical-site infection is associated with an important rate of complications and cost. One of the methods to decrees the incidence of SSI is using intrawound local vancomycin. The current evidence supporting the use of intra wound vancomycin powder in surgical wounds is limited and controversial Material and Methods A prospective, single-center, randomized, parallel group controlled trial will conduct in orthopedic department, Hamad General Hospital. 198 patients, 18 years or older patients, will undergo to open spine surgery with or without instrumentation, will be randomly assigned to receive intrawound vancomycin as intervention group or systemic antibiotic (stander of care) as control group. Exclusion criteria include hypersensitivity to vancomycin, Immune compromised status, Unable to continue in follow up. Result Primary outcome is the incidence of wound infection after open spine surgery for adult patients, and the secondary outcomes are total infection-related medical cost compared with the cost of vancomycin powder, Adverse effects of local vancomycin, Length of hospitalization. Wound infection will assess according to ASEPSIS score. Results will be analyzed using SPSS software (SPSS), Differences between two groups (control-intervention) will be tested using of t-test, Fisher's exact test. Conclusion The aim of this study is to detect the effectiveness of local vancomycin (intra-wound) in decreasing the post op surgical site infection in open spine surgery with or without instrumentation, and possible implanted as stander of care in Hamad General Hospital.

Effect of Using Local Intrawound Vancomycin Powder in Addition to Intravenous Antibiotics in Posterior Lumbar Surgery: Midterm Result in a Single-Center Study.

ObjectiveWe conducted this study to report the efficacy of local application of vancomycin powder in the setting of surgical site infection (SSI) of posterior lumbar surgical procedures and to figure out risk factors of SSIs.MethodsFrom February 2013 to December 2013, SSI rates following 275 posterior lumbar surgeries of which intrawound vancomycin powder was used in combination with intravenous antibiotics (Vanco group) were assessed. Compared with 296 posterior lumbar procedures with intravenous antibiotic only group from February 2012 to December 2012 (non-Vanco group), various infection rates were assessed. Univariate and multivariate analysis to figure out risk factors of infection among Vanco group were done.ResultsStatistically significant reduction of SSI in Vanco group (5.5%) from non-Vanco group (10.5%) was confirmed (p=0.028). Mean follow-up period was 8 months. Rate of acute staphylococcal SSIs reduced statistically significantly to 4% compared to 7.4% of non-Vanco group (p=0.041). Deep staphylococcal infection decreased to 2 compared to 8 and deep methicillin-resistant Staphylococcus aureus infection also decreased to 1 compared to 5 in non-Vanco group. No systemic complication was observed. Statistically significant risk factors associated with SSI were diabetes mellitus, history of cardiovascular disease, length of hospital stay, number of instrumented level and history of previous surgery.ConclusionIn this series of 571 patients, intrawound vancomycin powder usage resulted in significant decrease in SSI rates in our posterior lumbar surgical procedures. Patients at high risk of infection are highly recommended as a candidate for this technique.

Intrawound Vancomycin Powder Decreases Staphylococcal Surgical Site Infections After Posterior Instrumented Spinal Arthrodesis

A retrospective historical cohort design. To determine what effect the addition of intrawound vancomycin powder to the prophylactic regimen of posterior instrumented spinal arthrodesis procedures has had on acute surgical site infections (SSIs). SSIs are known complications in instrumented spinal arthrodesis procedures, and are predominately caused by Staphylococcus aureus. Recent reports have suggested that placing vancomycin powder into the surgical wound before closure prevents SSIs in spinal surgery. Risk factors for SSIs in the setting of intrawound vancomycin powder use have not been previously reported on. SSI rates after 342 posterior instrumented spinal arthrodeses (October 2008-September 2011) in which intrawound vancomycin powder was used in addition to the standard antimicrobial prophylaxis (Vanco cohort) were compared with 341 posterior instrumented spinal arthrodeses (April 2005-October 2008) in which no vancomycin powder was added (non-Vanco cohort). Both 2 sample t test and χ test (Fisher where appropriate) were used for group comparisons. A subanalysis of the Vanco cohort was undertaken to identify risk factors for SSIs despite intrawound vancomycin use. There was a significant reduction in the number of acute staphylococcal SSIs in the Vanco cohort (1.1%) compared with the non-Vanco cohort (3.8%; P=0.029). Deep staphylococcal infections decreased to 0 compared with 7 in the non-Vanco cohort (2.1%; P=0.008). Deep methicillin-resistant S. aureus infections decreased to 0 compared with 5 in the non-Vanco cohort (1.5%; P=0.031). A subanalysis of the Vanco cohort identified that being discharged to an inpatient rehabilitation or skilled nursing facility was associated with developing a SSI. Intrawound vancomycin powder use has decreased the rate of acute staphylococcal SSIs in our posterior instrumented spine arthrodesis surgeries. Patients who are discharged to skilled nursing or rehabilitation facilities are at an increased risk for developing SSIs despite intrawound vancomycin use.

HCP-22TOPICALLY APPLIED VANCOMYCIN POWDER REDUCES THE RATE OF SURGICAL SITE INFECTION IN PATIENTS UNDERGOING CRANIOTOMIES FOR PRIMARY BRAIN TUMORS

BACKGROUND: Surgical site infections (SSI) can increase postoperative morbidity, mortality and lead to increased health care costs. The rates of SSI can be as high as 5.8% in patients undergoing craniotomies for tumors. Local application of vancomycin powder has been shown to be effective in reducing SSI in spine surgery; however, the effectiveness and safety of vancomycin powder in craniotomy in unclear. METHODS: The authors performed a retrospective chart review of all patients who underwent craniotomies for resection of primary brain glioma at the Moffitt Cancer Center from 2004-2014. A protocol consisting of 1 g of intrawound vancomycin powder application was initiated at our institution in 2010. Patient demographics (age, gender), clinical characteristics (comorbidities, steroid dose, KPS), tumor characteristics (tumor type, location), surgical factors (primary or redo, length of surgery, blood loss), SSI rates were assessed. Multivariate analysis was performed to determine risk factors associated with SSI and rates. RESULTS: A total of 864 patients underwent craniotomies for primary brain tumors. The cohorts were similar in demographics and baseline comorbidities, KPS, tumor characteristics, and surgical factors. SSI rates at 90 days were reduced after the implementation of vancomycin powder. CONCLUSIONS: The use of vancomycin powder application in craniotomy led to a reduction in SSI. No significant adverse events were observed.

Serum and Wound Vancomycin Levels After Intrawound Administration in Primary Total Joint Arthroplasty

BackgroundPeriprosthetic joint infection is the most common cause of readmissions after total joint arthroplasty (TJA). Intrawound vancomycin powder (VP) has reduced infection rates in spine surgery; however, there are no data regarding VP in primary TJA. MethodsThirty-four TJA patients received 2 g of VP intraoperatively to investigate VP's pharmacokinetics. Serum and wound concentrations were measured at multiple intervals over 24 hours after closure. ResultsAll serum concentrations were subtherapeutic (<15μg/mL) and peaked 12 hours after closure (4.7μg/mL; standard deviation [SD], 3.2). Wound concentrations were 922 μg/mL (SD, 523) 3 hours after closure and 207 μg/mL (SD, 317) at 24 hours. VP had a half-life of 7.2 hours (95% confidence interval, 7.0-9.3) in TJA wounds. ConclusionsVP produced highly therapeutic intrawound concentrations while yielding low systemic levels in TJA. VP may serve as a safe adjunct in the prevention of periprosthetic joint infection.

Complications from the use of intrawound vancomycin in lumbar spinal surgery: a systematic review.

OBJECT The use of intrawound vancomycin is rapidly being adopted for the prevention of surgical site infection (SSI) in spinal surgery. At operative closure, the placement of vancomycin powder in the wound bed-in addition to standard infection prophylaxis-can provide high concentrations of antibiotics with minimal systemic absorption. However, despite its popularity, to date the majority of studies on intrawound vancomycin are retrospective, and there are no prior reports highlighting the risks of routine treatment. METHODS A MEDLINE search for pertinent literature was conducted for studies published between 1966 and May 2015 using the following MeSH search terms: "intrawound vancomycin," "operative lumbar spine complications," and "nonoperative lumbar spine complications." This was supplemented with references and known literature on the topic. RESULTS An advanced MEDLINE search conducted on May 6, 2015, using the search string "intrawound vancomycin" found 22 results. After a review of all abstracts for relevance to intrawound vancomycin use in spinal surgery, 10 studies were reviewed in detail. Three meta-analyses were evaluated from the initial search, and 2 clinical studies were identified. After an analysis of all of the identified manuscripts, 3 additional studies were included for a total of 16 studies. Fourteen retrospective studies and 2 prospective studies were identified, resulting in a total of 9721 patients. A total of 6701 (68.9%) patients underwent treatment with intrawound vancomycin. The mean SSI rate among the control and vancomycin-treated patients was 7.47% and 1.36%, respectively. There were a total of 23 adverse events: nephropathy (1 patient), ototoxicity resulting in transient hearing loss (2 patients), systemic absorption resulting in supratherapeutic vancomycin exposure (1 patient), and culture-negative seroma formation (19 patients). The overall adverse event rate for the total number of treated patients was 0.3%. CONCLUSIONS Intrawound vancomycin use appears to be safe and effective for reducing postoperative SSIs with a low rate of morbidity. Study disparities and limitations in size, patient populations, designs, and outcomes measures contribute significant bias that could not be fully rectified by this systematic review. Moreover, care should be exercised in the use of intrawound vancomycin due to the lack of well-designed, prospective studies that evaluate the efficacy of vancomycin and include the appropriate systems to capture drug-related complications.

Comparison of Intrawound Vancomycin Utility in Posterior Instrumented Spine Surgeries Between Patients With Tumor and Nontumor Patients.

Retrospective cohort study of consecutive patients. To compare the efficacy of intrawound vancomycin to prevent postoperative surgical site infection (SSI) between patients with spinal tumor and nontumor spine patients. Recent studies have suggested that intrawound vancomycin is a promising method for reducing the SSI rate in spine surgery. However, the patient population in which it is most effective remains unknown. Medical records of a consecutive series of patients with tumor and nontumor spine patients who underwent open posterior instrumented surgeries at our institution between October 2011 and June 2014 were reviewed. 1 gram of vancomycin powder was evenly sprayed into the surgical site before drain placement. The SSI rates before and after vancomycin use were compared. Changes in SSI rates, which reflected the utility of vancomycin, were compared between patients with tumor and nontumor patients. A total of 334 patients were enrolled including 25 patients with tumor and 129 nontumor patients in the "before" period, and 27 patients with tumor and 153 nontumor patients in the "after" period. Baseline characteristics in both patients with tumor and nontumor patients did not differ between periods. The SSI rate of nontumor patients was significantly reduced with intrawound vancomycin application (7.0% [9/129] vs. 0.7% [1/153], P = 0.011). However, the SSI rate in patients with tumor was not reduced (8.0% [2/25] vs. 14.8% [4/27], P = 0.442). 3 of the 4 patients with tumor who developed SSI after vancomycin use had previous radiotherapy, whereas only 1 SSI occurred in 14 patients with tumor without radiotherapy in the same period. Intrawound vancomycin may be beneficial for nontumor spine patients who undergo open posterior instrumented surgeries, but may not for those with spinal tumors. The poor physical health status, major surgical trauma, and tumor-related adjuvant treatments of patients with spinal tumor may contribute to this disparity.

Does the Use of Intrawound Vancomycin Decrease the Risk of Surgical Site Infection after Elective Spine Surgery? A Multicenter Analysis

Does the Use of Intrawound Vancomycin Decrease the Risk of Surgical Site Infection after Elective Spine Surgery? A Multicenter Analysis

166 Does the Use of Intrawound Vancomycin Decrease the Risk of Surgical Site Infection After Elective Spine Surgery?—A Multicenter Analysis

166 Does the Use of Intrawound Vancomycin Decrease the Risk of Surgical Site Infection After Elective Spine Surgery?—A Multicenter Analysis

Intrawound Vancomycin Powder for Spine Tumor Surgery.

Study Design Retrospective evaluation of prospectively collected data. Objective To evaluate infection rates following intrawound vancomycin powder application during spine tumor surgery. Methods Patients ≥18 years old undergoing spine tumor surgery and receiving intrawound vancomycin powder at a single center between January 2008 and January 2015 were enrolled. Patient demographics (age, sex, body mass index [BMI]), tumor type (metastatic, primary) and location, surgical data (estimated blood loss [EBL], levels fused, type of decompression, length of surgery and hospitalization, discharge status from hospital), radiation therapy use, and infection rates (surgery to a minimum of 30 days postoperative) were evaluated. Results Forty patients (46 procedures) undergoing spine tumor surgery and intrawound vancomycin powder application were identified. Five were excluded because of death less than 30 days postoperatively, and 35 patients (41 procedures) were enrolled: 11 women and 24 men with an average age of 61.4 years (range 19 to 92) and average BMI of 27.3 (range 17.4 to 36.8). Three cases were primary spine tumors. Five were hematologic malignancies, and 27 were metastatic cancers. Twenty-one tumors were in the thoracic spine, 12 in the lumbar spine, and 8 in the cervical spine. Average EBL was 899 mL (range 25 to 3,500), average length of surgery was 241 minutes (range 78 to 495), and average hospital stay was 15.1 days (range 3 to 49). Two culture-proven infections (Staphylococcus aureus, Enterobacter cloacae) were noted in 41 procedures (4.9%). Ten patients (28.6%) had preoperative radiation only; 14 (40%) had postoperative radiation only, 5 (14.3%) had both preoperative and postoperative radiation, and 6 (17.1%) had no radiation. There were no associations between radiation treatment and postsurgical infections (p = 0.19). Conclusion In this first study evaluating intrawound vancomycin powder for spine tumor surgery, we report an infection rate of 4.9%. We found no correlations between radiation treatment and postsurgical infections.

Should we add vancomycin antibiotic powder to prevent post operative infection in spine surgery?

Intravenous antibiotic prophylaxis is routinely administered to prevent surgical site infection in spinal surgery. Adding intrawound vancomycin powder before surgical closure might further decrease infection risk. However, its use is controversial. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified six systematic reviews that considered 16 studies, including one randomized controlled trial. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded vancomycin probably does not decrease the risk of infection in low risk surgery, but there is uncertainty about its effects in populations or surgeries with a higher risk because the certainty of the evidence is very low.

Surgical site infection in high-energy peri-articular tibia fractures with intra-wound vancomycin powder: a retrospective pilot study.

BackgroundSurgical site infections (SSI) continue to be a significant source of morbidity despite the introduction of perioperative intravenous antibiotics. Our objective was to assess the efficacy of local vancomycin powder on lowering deep SSI rates in high-energy tibial plateau and pilon fractures.Materials and methodsA retrospective review of all tibial plateau and pilon fractures treated in 2012 at our level I trauma center identified 222 patients. Of these, 107 patients sustained high-energy injuries that required staged fixation, and 93 had minimum 6 month follow-up. Ten patients received 1 gram vancomycin powder directly into the surgical wound at the time of definitive fixation, and the remaining 83 patients served as controls. SSI was defined according to criteria from the Centers for Disease Control. Demographic data, patient comorbidities, injury and treatment details, and infection details were recorded. Descriptive and comparative statistics were performed.ResultsAmongst the vancomycin powder group, 1 patient (10 %) developed a deep SSI; in the control group, 14 (16.7 %) developed deep SSI. The rate of deep SSI between the groups was not statistically significantly different (P = 1.0). The groups were statistically similar with regard to injuries, treatment, comorbidities, and infectious outcomes (P values range = 0.06–1.0).ConclusionsThe application of local vancomycin powder into surgical wounds of high-energy tibial plateau and pilon fractures did not reduce the rate of deep SSI in this retrospective review. There is a need to find effective, cheap, and widely available methods for prevention of SSI. Basic science and larger prospective clinical studies are needed to further delineate the role of local vancomycin powder as a modality to reduce deep SSI in extremity trauma.Level of evidence Level III, therapeutic.

Does Intrawound Application of Vancomycin Influence Bone Healing in Spinal Surgery?

Introduction Surgical site infections represent a major complication of spinal surgery. The application of lyophilized vancomycin into the wound is reported to significantly decrease infection rates. As concentrations applied locally can exceed the minimal bacterial inhibitory concentration for more than a 1000-fold, toxic side effects on local tissue may be possible. Materials and Methods Primary osteoblast cell cultures were generated from bone tissue samples of 10 patients. Samples were incubated in absence or presence of 3, 6, or 12 mg/cm2 vancomycin according to a planned phase I clinical trial protocol. Changes in pH, osteoblast migration, proliferation, and viability were analyzed. Alkaline phosphatase and mineralization patterns were studied. Results The application of more than 3 mg/cm2 vancomycin induced a decline of pH toward the acidic range. The migration potential of osteoblasts was decreased from 100% (control samples) to zero (12 mg/cm2 vancomycin) in a dose-dependent manner. Cell proliferation was significantly inhibited at dosages above 3 mg/cm2. Significant cell death was observed if the dosage applied exceeded 6 mg/cm2. The synthesis of alkaline phosphatase was markedly reduced in all dosages applied and calcium deposition was significantly decreased in dosages above 3 mg/cm2. Conclusion As bone remodeling requires the immigration, proliferation, and differentiation of osteoblasts at the fusion site, high dosages of intrawound vancomycin might interfere with regenerative processes and increase the risk of nonunion. To allow an appropriate balance of infection risk and the risk of nonunion, the minimal local concentration required should be determined by controlled in vivo studies.

Reducing surgical site infection in spinal surgery with betadine irrigation and intrawound vancomycin powder.

Retrospective analysis. The objective of this study was to evaluate the efficacy of a surgical site infection (SSI) prevention protocol instituted in the Orthopaedic Spine Department at our institution. SSI is an undesired complication of orthopedic spine surgical procedures. It poses a significant risk to the patient, as well as a financial toll on the health care system. A wide range of prophylactic measures have been used to attempt to reduce SSI rates. A protocol consisting of a combination of 0.3% Betadine wound irrigation and 1 g of intrawound Vancomycin powder application was developed at our institution. Multiple data sources were consolidated for thorough evaluation of changes in SSI rates, patient risk factors, and changes in bacteriology. Identification of risk factors that predispose patients to SSI was performed using mixed-effects logistic regression in a univariate fashion. Risk factors with P values of 0.05 or less in univariate analysis were included together in a multivariate mixed-effects logistic regression model. SSI rates were reduced by 50% after the intervention; χ analysis comparing the SSI rates between the pre- and postintervention periods yielded a P value of 0.042. Rates of methicillin-resistant Staphylococcus aureus dropped from 30% to 7% and the rates of multibacterial infections dropped from 37% to 27%. The risk factors that were statistically significant in multivariate analysis were the following: age (odds ratio [OR] = 0.93), anemia (OR = 30.73), prior operation (OR = 27.45), and vertebral fracture (OR = 22.22). The combination of Betadine wound irrigation and intrawound vancomycin powder application led to both a clinically and statistically significant decrease in SSI rates by 50%. Bacteriology analysis and risk factor assessment proved to be valuable tools in assessing the efficacy of a new prophylactic measure and in the planning of future protocols. 4.

Intrawound Vancomycin May Influence Postsurgical Bone Fusion

Intrawound Vancomycin May Influence Postsurgical Bone Fusion

Application of Intrawound Vancomycin Powder during Spine Surgery in a Patient with Dialysis-Dependent Renal Failure.

Surgical site infections (SSIs) after spinal surgery are a serious complication that can be minimized with prophylaxis. Vancomycin is a common agent used in the prevention of SSI. Given that vancomycin is renally cleared, its use requires careful observation in dialysis-dependent patients due to toxicity at supratherapeutic levels. Since minimum inhibitory concentrations (MICs) for vancomycin have increased due to the emergence of resistant pathogens, the use of vancomycin in such patients is further complicated. Local instillation of vancomycin powder is thought to provide additional protection against SSI and have lower systemic absorption. We present a patient with end-stage renal disease that developed progressively debilitating cervical spondylotic myelopathy necessitating multilevel laminectomy and instrumented fusion. Prior to closure, 1 gram of vancomycin powder was sprinkled into the surgical incision. Postoperative serum vancomycin levels were well below those associated with nephrotoxicity and ototoxicity. Based on this experience, we reviewed the relevant guidelines that were designed to prevent postoperative infections in such dialysis-dependent patients. Intrawound application of vancomycin may be a legitimate and safe option for SSI prophylaxis in patients with renal failure on dialysis.

Topical, Intrawound Vancomycin Powder Decreases the Risk of Surgical Site Infections in Complex Adult Deformity Reconstruction: A Cost-Benefit Analysis

Topical, Intrawound Vancomycin Powder Decreases the Risk of Surgical Site Infections in Complex Adult Deformity Reconstruction: A Cost-Benefit Analysis

Local intrawound vancomycin powder decreases the risk of surgical site infections in complex adult deformity reconstruction: a cost analysis.

Retrospective cohort analysis. To evaluate the rate of surgical site infections (SSIs) and cost-effectiveness of the use of intraoperative vancomycin powder in thoracolumbar adult deformity procedures. The rates of SSI remain unacceptably high in adult spinal deformity surgery despite routine intravenous antibiotics. Vancomycin powder applied directly to the wound intraoperatively has shown promise for decreasing SSI in spine surgery. Adults who underwent adult deformity reconstruction by 2 surgeons between 2008 and 2012 with a minimum of 3 months of clinical follow-up were retrospectively reviewed. The patients were subdivided into those who had received only routine perioperative intravenous antibiotics (control) and those who received intravenous antibiotics and 2 g of vancomycin powder applied into the surgical wound. The primary outcome was SSI within 90 days. Secondary outcomes included surgical/clinical parameters and SSI-related medical costs based on hospital billing records. Two hundred fifteen patients were evaluated-controls (n=64) and vancomycin powder group (n=151). The average number of levels fused was 10 (5-17, control) and 12 (5-19, vancomycin). The mean follow-up was 34 months (3-68 mo, control) and 18 months (3-35 mo, vancomycin) (P<0.05). There were significantly fewer hospital readmissions within 90 days for SSI in patients who received vancomycin powder (2.6%; 4/151) compared with controls (10.9%; 7/64) (P=0.01). There were no reported adverse events related to the intrawound vancomycin use. The average cost per patient of treating a postoperative SSI was higher in the control group ($34,388) than in the study group ($28,169). With the use of vancomycin powder, there was a cost saving of $244,402 per 100 complex spinal procedures. Local application of vancomycin powder significantly decreased SSI for adults undergoing spinal reconstructive surgery. This resulted in cost savings of $244,402 per 100 thoracolumbar adult deformity procedures. 3.

A meta-analysis of spinal surgical site infection and vancomycin powder.

Surgical site infection (SSI) is a serious and costly complication of spinal surgery. There have been several conflicting reports on the use of intrawound vancomycin powder in decreasing SSI in spine surgery. The purpose of this study is to answer the question: "Does intrawound vancomycin powder reduce the rate of SSIs in spine surgery?" A comprehensive search of multiple electronic databases and bibliographies was conducted to identify clinical studies that evaluated the rates of SSI with and without the use of intrawound vancomycin powder in spine surgery. Independent reviewers extracted data and graded the quality of each paper that met inclusion criteria. A random effects meta-analysis was then performed. The search identified 9 retrospective cohort studies (Level III evidence) and 1 randomized controlled trial (Level II evidence). There were 2574 cases and 106 infections in the control group (4.1%) and 2518 cases and 33 infections (1.3%) in the treatment group, yielding a pooled absolute risk reduction and relative risk reduction of 2.8% and 68%, respectively. The meta-analysis revealed the use of vancomycin powder to be protective in preventing SSI (relative risk = 0.34, 95% confidence interval 0.17-0.66, p = 0.021). The number needed to treat to prevent 1 SSI was 36. A subgroup analysis found that patients who had implants had a reduced risk of SSI with vancomycin powder (p = 0.023), compared with those who had noninstrumented spinal operations (p = 0.226). This meta-analysis suggests that the use of vancomycin powder may be protective against SSI in open spinal surgery; however, the exact population in which it should be used is not clear. This benefit may be most appreciated in higher-risk populations or in facilities with a high baseline rate of infection.