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A meta-analysis of spinal surgical site infection and vancomycin powder
Nickalus R Khan1, Clinton J Thompson, Michael DeCuypere
1Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee;
Object:
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?"
Methods:
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.
Results:
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).
Conclusions:
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.
Insights
Intrawound vancomycin powder significantly reduces surgical site infections (SSIs) in spinal surgery. This meta-analysis found a 68% relative risk reduction in SSIs, suggesting its protective effect, especially in patients with implants.
Area of Science:
- Orthopedics
- Infectious Disease
- Surgical Outcomes
Background:
- Surgical site infection (SSI) is a significant complication in spinal surgery.
- Conflicting evidence exists regarding the efficacy of intrawound vancomycin powder in preventing SSIs.
- This study addresses the clinical question of vancomycin powder's effectiveness in reducing spinal surgery SSIs.
Purpose of the Study:
- To determine if intrawound vancomycin powder reduces the incidence of surgical site infections (SSIs) in patients undergoing spinal surgery.
Main Methods:
- A comprehensive literature search was performed across multiple electronic databases.
- Included studies were reviewed by independent reviewers who extracted data and assessed quality.
- A random-effects meta-analysis was conducted on eligible clinical studies.
Main Results:
- The analysis included 9 retrospective cohort studies and 1 randomized controlled trial, totaling 5092 cases.
- Intrawound vancomycin powder use was associated with a significant reduction in SSI rates (1.3% vs. 4.1%).
- A pooled relative risk reduction of 68% was observed, with a number needed to treat of 36. Patients with spinal implants showed a statistically significant benefit.
Conclusions:
- Intrawound vancomycin powder appears to be protective against surgical site infections in open spinal surgery.
- The benefit may be most pronounced in higher-risk patient populations or facilities with elevated baseline infection rates.
- Further clarification is needed regarding the precise patient populations that benefit most from its use.
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