Risk Of Postoperative Wound Infection Research Articles

Risk factors of surgical site infection in geriatric orthopedic surgery: A retrospective multicenter cohort study.

As we are experiencing the progressive aging of our population, risk management of geriatric orthopedic patients is extremely important. The present study was carried out to identify independent predictors of surgical site infection and to better define the threshold value of serum albumin on postoperative wound infection in older patients. This retrospective multicenter study was carried out from January 2015 to June in 2017. A total of 3378 older patients (aged ≥60 years) were enrolled. We extracted the patients' demographics, characteristics of disease, treatment-related variables and indexes of laboratory examination. Receiver operating characteristic analysis was carried out to find the optimum cut-off value for serum albumin. Univariate and multivariate logistic analysis models were carried out, respectively, to determine independent predictors of surgical site infection. A total of 123 patients developed wound infection in the present study. Surgical site infection prolonged hospitalization of patients by a mean of 14.2 days. The overall incidence was 3.64%, with 0.47% for deep infection and 3.16% for superficial infection. Independent predictors of surgical site infection identified by multivariate analysis were traumatic injury (odds ratio 12.42, 95% CI 6.80-22.12; P = 0.000), serum albumin <32.6 g/L (odds ratio 2.54, 95% CI 1.22-5.29; P = 0.013) and American Society of Anesthesiologists physical status index class 3 or higher (odds ratio 2.14, 95% CI = 1.24-3.69; P = 0.006). We recommend that surgeons evaluate the nutritional status of older patients and optimize the perioperative strategy of supplementary nutrition support to reduce the risk of postoperative wound infection. Geriatr Gerontol Int 2019; 19: 213-217.

Two-stage treatment in patients with patients with high-energy femoral fractures does not lead to an increase in deep infectious complications: a propensity score analysis

PurposeIn patients following severe trauma sometimes the physiological condition or soft tissue status may not allow definitive fixation of a femoral fracture. In these patients, an external fixator can be placed to temporarily stabilise the fracture, after which definitive fixation can be performed in a second procedure. The aim of this study was to compare the postoperative wound infection and union rates of patients treated with direct intramedullary nailing (IMN) and patients treated with the ‘two-stage treatment’.MethodsAll patients with high-energy femoral fractures treated with IMN between 2000 and 2016 in a single Level 1 trauma centre were eligible. Electronic charts were reviewed for patient and surgical characteristics; furthermore, the development of complications was noted. A propensity score analysis was performed to assess the attributed risk of the external fixator on the development of postoperative wound infections.ResultsA total of 149 patients were included in this study; 93 underwent direct IMN and 56 underwent the two-stage treatment. Patients who underwent two-stage treatment were more severely injured, reflected by lower EMV and higher ISS on admission. Patients in the two-stage treatment group had a significant higher risk of postoperative wound infections (OR: 4.698, 95% CI: 1.203–18.339) but not a higher risk on deep postoperative wound infections (OR 2.345, 95% CI: 0.439–12.540). Union rate did not differ between the two groups (94% vs 94% NS).ConclusionsThe two-stage treatment is a safe treatment option in patients with a high-energy femoral fracture in terms of postoperative wound infections. Union rates are also comparable between the two treatment groups.

Prophylactic Groin Wound Vacuum-assisted Therapy in Vascular Surgery Patients at Enhanced Risk for Postoperative Wound Infection

Vascular groin wounds have higher than expected surgical site infection (SSI) rates and some patients are at enhanced risk. The Wiseman etal. paper suggests an objective scoring system that identifies patients at enhanced risk of postdischarge SSI. We hypothesize that prophylactic groin wound vacuum-assisted closure (VAC) therapy in enhanced risk patients will decrease SSI and readmission and the Wiseman model provides potential evidence that enhanced risk patients can be objectively identified. A single institution, retrospective analysis was conducted from January 2013 to September 2016 utilizing procedure codes to identify patients with wound VACs placed in the operating room. Two distinct groups were identified. The first was a wound complication patient group with 15 limbs (13 patients) with a groin wound VAC placed within 45days postoperatively for groin wound complications. Eleven of these limbs had the VAC placed at readmission. The second group was a prophylactic patient group that included 8 limbs (7 patients) who received a VAC prophylactically placed in the enhanced risk wounds. These wounds were determined to be enhanced risk based on clinical criteria judged by the operating surgeon such as a large overhanging panniculus and/or one of several ongoing medical issues. We calculated a Wiseman score for all patients, determined total cost of the readmissions, and determined 30-day postsurgical SSI incidence for the prophylactic VAC group. Per the Wiseman scores, 9 limbs with postoperative complications were high risk and 3 limbs were moderate/high risk. Eleven limbs had a VAC placed at readmission with an average readmission cost of $8876.77. For the prophylactic group, 8 limbs were high risk with no observed postdischarge SSI in the first 30days from surgery. The Wiseman scores showed close correlation between the retrospective high and moderate/high risk groups versus the prophylactic VAC group (31.5 ± 7.3 vs. 32 ± 5.5, P=0.87). The Wiseman scores showed objective validation in the prognosis of anticipating groin wound breakdown. Our initial results suggest that prophylactic groin wound VAC placement for enhanced risk vascular surgery patients may proactively decrease wound morbidity, decrease readmission secondary to groin wound complications, and provide some cost benefit.

Early pathogenic colonisers of acute burn wounds: A retrospective review

BackgroundEarly excision of burns reduces the incidence of local and systemic infections caused by colonising microorganisms, and reduces mortality and length of hospital stay. Appropriate antibiotic prophylaxis can reduce the risk of postoperative wound infections and skin graft loss. Antibiotic selection should be based on likely pathogens. However, there are few studies that have investigated the early pathogenic colonisers of acute burn wounds. AimTo describe pathogenic microorganisms found in acute burns and to make further recommendations on the use of early perioperative prophylactic antibiotics. MethodsAll burns patients admitted at the tertiary adult burns centre in Victoria over a 2-year period, who had surface swabs or tissue samples obtained from wounds within 24h of injury were included in this retrospective cohort study. Pathogenic organisms were examined with respect to patient characteristics, burn characteristics, treatment provided and immediate exposure to environmental contaminants. ResultsNearly one third of burns patients had wounds colonised with pathogenic microorganisms. Gram-negative bacteria were isolated from 52% of these. Staphylococcus aureus was the most common isolate. Pseudomonas and Enterobacter species were the most common gram-negatives. The only independent risk factor associated with early colonisation with gram-negative bacteria was per cent TBSA burn. ConclusionIncreased colonisation of acute burn wounds with pathogenic gram-negative bacteria was associated with increased size of burn.

Hemoglobin A1c as a Predictor of Postoperative Infection Following Elective Forefoot Surgery.

There remains little evidence to support a perioperative hemoglobin A1c (HbA1c) level that could serve as a threshold for a significantly increased risk of postoperative surgical site infection (SSI) following forefoot surgery. A national database was queried for patients who underwent elective forefoot surgery with diabetes. Patients with a perioperative HbA1c level within 3 months of surgery were identified and stratified based on HbA1c level in 0.5 mg/dL increments. The incidence of SSI was determined by either a diagnosis or procedure for SSI within 1 year and a receiver operating characteristic (ROC) curve and area under the curve (AUC) analysis was performed to determine an optimal threshold value of HbA1c. A total of 4630 patients who underwent forefoot surgery with diabetes with a perioperative HbA1c were included. The rate of SSI ranged from 2.3% to 11.8%. The inflection point of the ROC curve corresponded to an HbA1c level above 7.5 mg/dL ( P < .0001; 95% confidence interval [CI] = 0.58-0.67; AUC = 0.631; specificity = 75%; sensitivity = 46%). After multivariate analysis, patients with an HbA1c level of 7.5 mg/dL or greater had a significantly higher risk for postoperative wound infection compared to patients below this threshold (OR = 1.92; 95% CI = 1.5-2.4; P < .0001). The risk of postoperative SSI following forefoot surgery increased as the perioperative HbA1c increased. ROC analysis determined that a perioperative HbA1c above 7.5 mg/dL could serve as a threshold for a significantly increased risk of postoperative SSI following forefoot surgery. Level III, comparative series.

Prophylactic Groin Wound VAC Therapy? - Evidence for a “Pre-Emptive Strike” in Vascular Surgery Patients at Enhanced Risk for Postoperative Wound Infection

Prophylactic Groin Wound VAC Therapy? - Evidence for a “Pre-Emptive Strike” in Vascular Surgery Patients at Enhanced Risk for Postoperative Wound Infection

Intraoperative dexamethasone does not increase the risk of postoperative wound infection: a propensity score-matched post hoc analysis of the ENIGMA-II trial (EnDEX)

BackgroundIn a post hoc analysis of the ENIGMA-II trial, we sought to determine whether intraoperative dexamethasone was associated with adverse safety outcomes. MethodsInverse probability weighting with estimated propensity scores was used to determine the association of dexamethasone administration with postoperative infection, quality of recovery, and adverse safety outcomes for 5499 of the 7112 non-cardiac surgery subjects enrolled in ENIGMA-II. ResultsDexamethasone was administered to 2178 (40%) of the 5499 subjects included in this analysis and was not associated with wound infection [189 (8.7%) vs 275 (8.3%); propensity score-adjusted relative risk (RR) 1.10; 95% confidence interval (CI) 0.89–1.34; P=0.38], severe postoperative nausea and vomiting on day 1 [242 (7.3%) vs 189 (8.7%); propensity score-adjusted RR 1.06; 95% CI 0.86–1.30; P=0.59], quality of recovery score [median 14, interquartile range (IQR) 12–15, vs median 14, IQR 12–16, P=0.10), length of stay in the postanaesthesia care unit [propensity score-adjusted median (IQR) 2.0 (1.3, 2.9) vs 1.9 (1.3, 3.1), P=0.60], or the primary outcome of the main trial. Dexamethasone administration was associated with a decrease in fever on days 1–3 [182 (8.4%) vs 488 (14.7%); RR 0.61; 95% CI 0.5–0.74; P<0.001] and shorter lengths of stay in hospital [propensity score-adjusted median (IQR) 5.0 (2.9, 8.2) vs 5.3 (3.1, 9.1), P<0.001]. Neither diabetes mellitus nor surgical wound contamination status altered these outcomes.Conclusion. Dexamethasone administration to high-risk non-cardiac surgical patients did not increase the risk of postoperative wound infection or other adverse events up to day 30, and appears to be safe in patients either with or without diabetes mellitus. Clinical trial registrationNCT00430989.

411: The impact of low dose versus high dose antibiotic prophylaxis regimens on surgical site infection rates after cesarean delivery

To determine if high dose antibiotic prophylaxis prior to cesarean delivery (CD) decreases the risk of postoperative wound infection compared with low dose. Two preoperative antibiotic regimens were compared: Low dose (cefazolin 1 g unless BMI > 35 kg/m2 then 2 g) and high dose (cefazolin 2 g unless BMI > 35 kg/m2 then 3 g). The primary outcome was surgical site infection (SSI) based on the Centers for Disease Control and Prevention criteria. Sample size of 343 patients per group was calculated for a 50% reduction in risk for SSI. Univariable and multivariable logistic regression analyses were performed and a P<0.05 was considered statistical significant. A total of 730 women were included. Demographics are shown in Table 1. During this period the incidence of SSI was 5%. On univariable analysis, women who had SSI were more likely to be Caucasian, Black, smokers, hypertensive and had a higher estimated blood loss at delivery (Table 2). The rate of SSI did not differ between the low and high dose groups (14/367 (4%) vs 19/365 (5%), P=0.38). The rate of SSI in high vs low remain no different after adjusting for the above covariates (aOR 1.75, 95% CI [0.91-4.40]; (Table 3). Higher dosages of antibiotic prophylaxis did not decrease the rates of SSI compared to the usual doses. Further Level 1 randomized clinical trials are needed to support our observation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Changing the Adverse Event Profile in Metastatic Spine Surgery: An Evidence-Based Approach to Target Wound Complications and Instrumentation Failure.

Systematic review. To identify risk factors and preventive methods for wound complications and instrumentation failure after metastatic spine surgery. We focused on two postoperative complications of metastatic spine tumor surgery: wound complications and instrumentation failure and preventive measures. We performed a systematic review of the literature from 1980 to 2015. The articles were analyzed for the presence of documented infection and/or wound complications and instrumentation failure. Forty articles met our inclusion criteria for wound complications and prevention. There is very low level of evidence that preoperative radiation, preoperative neurological deficit, revision procedures, and posterior approaches can contribute to wound complications (infections, wound dehiscence). There is very low level of evidence that plastic surgery soft tissue reconstruction, intrawound vancomycin powder, and percutaneous pedicle screws may prevent postoperative wound complications. Fourteen articles met our inclusion criteria for instrumentation failure. There is very low level of evidence that constructs greater than six levels, positive sagittal balance, preoperative radiation, and history of chest wall resection can contribute to implant failures. • For patients undergoing revision metastatic spine tumor surgery, plastic surgery should perform the soft tissue reconstruction (strong recommendation/very low quality of evidence).• For patients undergoing metastatic spine tumor surgery, plastic surgery may perform immediate soft tissue reconstruction (weak recommendation/very low quality of evidence).• For patients undergoing metastatic spine tumor surgery, intrawound vancomycin can be applied to decrease the risk of postoperative wound infections (weak recommendation/very low quality of evidence).• For patients undergoing metastatic spine tumor surgery, percutaneous pedicle screws can be placed to decrease the risk of postoperative wound complications (weak recommendation/very low quality of evidence).• Instrumentation failure risk factors include constructs greater than six levels, positive sagittal balance, preoperative radiation, and history of chest wall resections (weak recommendation/very low quality of evidence). N/A.

The Effect of Patient Warming During Cesarean Delivery on Maternal and Neonatal Outcomes: A Meta-Analysis

(Br J Anaesth. 2015;115(4):500–510) The use of periperative warming is recommended for surgery under anesthesia, as it can help lower the risk of postoperative wound infection, myocardial ischemia, perioperative coagulopathy, blood loss, and transfusion requirements. However, there are currently no European or American national recommendations on the use of warming prior to and during cesarean delivery and it is not widely practiced. This study looked at the effect of active warming for elective cesarean deliveries on maternal temperature and comfort, neonatal temperature, umbilical cord pH, and Apgar scores.

Single-incision laparoscopic appendectomy is comparable to conventional laparoscopic and laparotomic appendectomy: our single center single surgeon experience.

Several studies have demonstrated the clinical and technical benefits of the laparoscopic surgery for complicated and uncomplicated appendicitis. Our retrospective study included 12 patient who underwent SILS appendectomy (SILS-A), 14 who received conventional laparoscopic surgery (VL-A), and 12 who received laparotomic appendectomy (OA); performed in all cases by the same surgeon (C.F.). The aim of this study was the comparison between this three different surgical techniques on same features: post operative leukocytosis, post operative pain, need abdominal drainage, esthetic viewpoint, incidence of complication, hospital stay. The results showed no significant differences between SILS-A and VLS-A, while an evident improvement shows versus O-A, even though not statistically significative. SILS was more effective in decreasing the risk of postoperative wound infection.

Current status of post-operative antibiotic prophylaxis in surgical wards

Background: Appropriate antibiotic prophylaxis can reduce the risk of post-operative wound infections, but misuse and overuse of antibiotics increase cost and emergence of resistant bacteria. Despite the existence of general recommendations for antibiotic prophylaxis, many deviations from these recommendations are still reported notably for antibiotic choice and duration of prophylactic administration. Objective: This study was conducted to evaluate the pattern of post-operative prophylactic antibiotics in surgical wards at Dhiraj Hospital, a tertiary care teaching hospital attached with SBKS Medical Institute and Research Center, Piparia, Vadodara, Gujarat, India. Materials and Methods: In this prospective observational study, a total of 200 patients from various surgical wards were included. Pretested pro forma which included information on choice of antimicrobial agents as well as their route, number and total duration of prophylaxis were completed. Furthermore, appropriateness of antibiotic prophylaxis was assessed as per standard guidelines. Results: All the patients received post-operative antibiotic doses. The majority of patients (98, 49%) were prescribed three antibiotics. Most of the post-operative use of antibiotics was not as per standard guidelines in terms of choice of antibiotics and total duration of treatment. The patients received post-operative antibiotics for a mean duration of 9.84 days during their hospital stay. Conclusion: In spite of existence of the written guidelines for antimicrobial surgical prophylaxis, there are significant deviations from the recommendations in current clinical practice. To promote the rational use of antibiotics in surgical prophylaxis, implementation of and adherence to evidence-based guidelines and recommendations for antimicrobial surgical prophylaxis is strictly required.

Single-Port Laparoscopy-Assisted Appendectomy in Children: A Method Described

Single-incision laparoscopic appendectomy (SILA) has gained popularity in children, and several different techniques have been described, including intracorporeal and extracorporeal techniques and single-channel and multi-channel single-port techniques. However, there has been a concern that exteriorizing an infected appendix through the umbilical channel would increase the risk of postoperative wound infections. This report aims to describe a technique for single-port laparoscopy-assisted appendectomy (SPLAA) using an operative laparoscope and conventional laparoscopic instruments, as well as a VersaStep™ sheath to protect the wound edge while removing the appendix from the abdomen.

Incidence of postoperative wound infections after open tendo Achilles repairs.

Tendo Achilles (TA), which is the confluence of the gastrocnemius and soleus muscles, is one of the most commonly injured tendons. The surgical repair of TA ruptures is associated with a significant risk of infection. This study examined several factors (i.e. gender, age, body mass index, history of diabetes mellitus, steroid use, acute or chronic TA injuries, type of surgical incision and type of sutures used) that may be associated with postoperative wound infection after open TA repair. This was a retrospective study involving 60 patients who underwent open TA repair over an 18-month period. Patients who had prior TA surgery or open TA injuries, or who needed soft tissues flaps were excluded. Among the patients, 7 (11.7%) developed superficial wound infections that were successfully treated with oral antibiotics, while 3 (5.0%) developed deep wound infections that required at least one debridement procedure. No significant association was found between the risk of postoperative wound infection and gender, age, the presence of diabetes mellitus, acute or chronic ruptures, site of surgical incision and type of deep or superficial sutures used. While diabetes mellitus and age did not appear to be associated with postoperative wound infections after open TA repair, obese patients were found to be two times more likely to develop a wound infection than normal-weight patients. The incidence of superficial wound infections in this study was similar to previously published results (11.7% vs. 8.2%-14.6%), but the incidence of deep infections was higher (5% vs. 1%-2%).

Risk factors for post-operative wound infection in the setting of chorioamnionitis and cesarean delivery

Objective: The objective of this study was to identify factors associated with an increased risk of post-operative wound infection in women with chorioamnionitis who undergo cesarean delivery.Methods: We conducted a retrospective cohort study of women with clinical chorioamnionitis who underwent cesarean delivery at a tertiary-care center between June 2010 and May 2013. Demographic data, labor and delivery details and post-operative outcomes were collected. Women with and without post-operative wound infections were compared.Results: Of 213 women with clinical chorioamnionitis who underwent cesarean delivery, 32 (15%) developed wound infections. Women with wound infection were more likely to have a body mass index (BMI) greater than or equal to 40 (p = 0.04), chronic hypertension (p = 0.03), leukocytosis on presentation (p = 0.046) or use tobacco (p = 0.002). Women who received ertapenem postpartum were less likely to develop wound infection than those who did not receive antibiotics (p = 0.02) or those that received ampicillin, gentamicin and clindamycin (p = 0.005).Conclusions: Elevated BMI, tobacco use, chronic hypertension and leukocytosis at admission were associated with an increased risk of wound infection. Ertapenem appeared to reduce the risk of post-operative wound infections in women who had chorioamnionitis and underwent cesarean delivery. This could be considered as a treatment option for this high-risk population.

Wound Healing Following Open Groin Hernia Surgery: The Impact of Comorbidity.

The aim of this study was to explore the impact of chronic concomitant disease on the risk for postoperative complications following open groin hernia surgery. During the study period (2002-2011), 133,074 open repairs were registered in the Swedish Hernia Register. History of peripheral vascular disorders, connective tissue disease, chronic renal failure, obesity, and liver cirrhosis as well as data on hemorrhage or hematoma, wound dehiscence, postoperative infection, and reoperation for superficial infection or bleeding within 30 days after surgery were obtained by matching with the Swedish Patient Register. In the multivariate logistic regression analysis, a significantly increased risk for hemorrhage or hematoma within 30 days after surgery was seen for older patients, males, liver cirrhosis, peripheral vascular disease, and connective tissue disease (p < 0.05). High age (>80 years), previous history of peripheral vascular disease, connective tissue disease, and male gender were risk factors for wound dehiscence (p < 0.05). Liver cirrhosis, chronic kidney disease, BMI > 25, and male gender were associated with increased risk for postoperative wound infection (p < 0.05). A significantly increased risk for reoperation for superficial infection or bleeding was seen in patients with peripheral vascular disease and elderly patients (p < 0.05). Risk for postoperative complications in open groin hernia surgery is increased in elderly patients, patients with liver cirrhosis, and those with peripheral vascular disease. The indications for surgery should be weighed against the risk for wound-healing complications in these patient groups. Watchful waiting may be an alternative, although this carries the risk of emergency surgery.

Increased Risk of Infection in Obese Adolescents After Pedicle Screw Instrumentation for Idiopathic Scoliosis

Study DesignOriginal research. ObjectiveTo evaluate perioperative risk factors associated with obesity in children undergoing posterior spinal fusion for adolescent idiopathic scoliosis. The authors hypothesized that patients with a high body mass index (BMI) percentile would be associated with increased morbidity as measured by various intraoperative parameters. Summary of Background DataFew studies have evaluated the effects of increased BMI in children undergoing surgery. Adolescent idiopathic scoliosis represents 80% of idiopathic scoliosis cases and is the most common indication for surgery. MethodsPatients were divided into 3 groups: normal weight (n = 144) (5% < BMI < 85%), overweight (n = 25) (BMI > 85% to 95%), and obese (n = 38) (BMI > 95%). Patients with BMI less than 5% were excluded from this study because they were underweight. Perioperative data were collected and analyzed based on differences between groups. ResultsA total of 207 patients were included in this study. There was a significant difference in the length of anesthesia (p = .032). The rate of infection was 11% in the obese group, 12% in the overweight group, and 3% in the normal weight group (p = .03). ConclusionsEven with pedicle screw instrumentation, the researchers saw an increase in infection in overweight and obese patients. Patients should be counseled before surgery for weight loss to limit surgical complications such as possible risk of postoperative wound infection.

A Review of Surgical Techniques in Spinal Cord Stimulator Implantation to Decrease the Post-Operative Infection Rate

The use of spinal cord stimulator has been supported by the evidence-based studies at moderate level to control varying etiologies of pain. Infections are the most serious complications encountered in spinal cord stimulator implantation. The intent of this article is to present available studies and literature for surgical techniques to reduce the risks of postoperative wound infection for spinal cord implantation.

Vaginal disinfection before cesarean delivery in preventing postoperative infections: a meta-analysis

Objective To analyze the efficacy of vaginal disinfection with povidone-iodine before cesarean delivery in preventing postoperative infections.Methods Randomized controlled trials,identified from a systematic search of relevant databases including PubMed,EMBASE,CBM,CNKI,and CQVIP,were screened and evaluated according to standardized criteria.RevMan 5.2software was used to do the meta-analysis.Results A total of 9randomized controlled trials with 3 024 participants,with 1 508 in the vaginal cleansing group and 1 516 in the control group,were included in this meta-analysis.The analysis result showed that vaginal disinfection with povidone-iodine before cesarean delivery reduced the incidence of postcesarean endometritis(RR=0.55,95% CI 0.36-0.85,P =0.007).The incidence of post-cesarean endometritis was significantly reduced in women with ruptured membranes(RR=0.29,95%CI:0.16-0.52,P0.000 1)and women in labor(RR=0.63,95%CI 0.41-0.96,P=0.03),but not significantly reduced in the women with intact membranes(RR=0.73,95%CI 0.50-1.08,P=0.11)or women not in labor(RR=0.79,95%CI 0.53-1.17,P=0.24).Vaginal disinfection could not help to reduce the incidence of postoperative wound infection(RR=0.80,95%CI 0.53-1.22,P=0.30)or postoperative fever(RR=0.92,95%CI 0.76-1.11,P=0.37).Conclusion Vaginal disinfection with povidone-iodine before cesarean delivery can decrease the risk of post-cesarean endometritis,especially for women undergoing cesarean delivery with ruptured membranes or in labor,but vaginal disinfection do not reduce the risk of postoperative wound infection or fever.

Efficacy of Antibiotics Sprayed into Surgical Site for Prevention of the Contamination in the Spinal Surgery.

Study DesignRetrospective study.PurposeTo evaluate the effect of intraoperative wound application of vancomycin on preventing surgical wound contamination during instrumented lumbar spinal surgery.Overview of LiteraturePostoperative infection is the one of the most devastating complications of lumbar surgery. There are a few reports showing the benefits of intraoperative wound application of vancomycin during spinal surgery. However, there is no report about the effectiveness of local vancomycin instillation in prevention of surgical wound contamination.MethodsEighty-six patients underwent instrumented lumbar spinal surgery. Mean patient age was 65.19 years (range, 23-83 years). There were 67 females and 19 males. During surgery, vancomycin powder was applied into the surgical site before closure in 43 patients (antibiotic group) and vancomycin powder was not applied into the surgical site before closure in 43 patients (control group). The tip of the surgical drain was cultured to evaluate surgical wound contamination. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured on the first, third, seventh, and fourteenth day after the operation.ResultsWe found two patients with a positive culture from the tip of surgical drains in the antibiotic group, and one patient with a positive culture from the tip of the surgical drain in the control group. Postoperative ESR and CRP levels did not show significant differences between the two groups. On the third postoperative day, ESR in patients of the antibiotic group was more significantly decreased than that in patients of the control group, while CRP level did not show a significant difference between the two groups.ConclusionsThere was no evidence to suggest that intraoperative vancomycin application is effective in decreasing the risk of postoperative wound infection after instrumented posterior lumbar fusion surgery.