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Intraoperative Ultrasound in Spinal Surgery
Published on: August 17, 2022
Is Intraoperative Local Vancomycin Powder the Answer to Surgical Site Infections in Spine Surgery?
Hwee Weng Dennis Hey1, Desmond Wei Thiam2, Zhi Seng Darren Koh1
1Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.
Study Design:
This is a retrospective cohort comparative study of all patients who underwent instrumented spine surgery at a single institution.
Objective:
To compare the rate of surgical site infection (SSI) between the treatment (vancomycin) and the control group (no vancomycin) in patients undergoing instrumented spine surgery.
Summary Of Background Data:
SSI after spine surgery is a dreaded complication associated with increased morbidity and mortality. Prophylactic intraoperative local vancomycin powder to the wound has been recently adopted as a strategy to reduce SSI but results have been variable.
Methods:
In the present study, there were 117 (30%) patients in the treatment group and 272 (70%) patients in the comparison cohort. All patients received identical standard operative and postoperative care procedures based on protocolized department guidelines. The present study compared the rate of SSI with and without the use of prophylactic intraoperative local vancomycin powder in patients undergoing various instrumented spine surgery, adjusted for confounders.
Results:
The overall rate of SSI was 4.7% with a decrease in infection rate found in the treatment group (0.9% vs. 6.3%). This was statistically significant (P = 0.049) with an odds ratio of 0.13 (95% confidence interval 0.02-0.99). The treatment group had a significantly shorter onset of infection (5 vs. 16.7 days; P < 0.001) and shorter duration of infection (8.5 vs. 26.8 days; P < 0.001). The most common causative organism was Pseudomonas aeruginosa (35.2%). Patient diagnosis, surgical approach, and intraoperative blood loss were significant risk factors for SSI after multivariable analysis.
Conclusion:
Prophylactic Intraoperative local vancomycin powder reduces the risk and morbidity of SSI in patients undergoing instrumented spine surgery. P. aeruginosa infection is common in the treatment arm. Future prospective randomized controlled trials in larger populations involving other spine surgeries with a long-term follow-up duration are recommended.
Level Of Evidence:
3.
Insights
Prophylactic intraoperative vancomycin powder significantly reduced surgical site infections (SSI) in instrumented spine surgery patients. This intervention also decreased infection onset and duration, highlighting its benefit in preventing complications.
Area of Science:
- Spine Surgery
- Infectious Disease
- Pharmacology
Background:
- Surgical site infection (SSI) is a significant complication following instrumented spine surgery, increasing patient morbidity and mortality.
- Intraoperative vancomycin powder is increasingly used to prevent SSI, but its efficacy remains variable.
- Understanding risk factors and effective prophylactic strategies is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the incidence of surgical site infection (SSI) in patients undergoing instrumented spine surgery who received prophylactic intraoperative vancomycin powder versus those who did not.
- To evaluate the impact of vancomycin powder on the onset and duration of SSI.
- To identify risk factors associated with SSI in this patient population.
Main Methods:
- Retrospective cohort comparative study including patients who underwent instrumented spine surgery.
- Comparison of SSI rates between a treatment group (vancomycin powder) and a control group (no vancomycin).
- Statistical analysis adjusted for potential confounders to determine the efficacy of vancomycin prophylaxis.
Main Results:
- The vancomycin treatment group showed a significantly lower SSI rate (0.9%) compared to the control group (6.3%), with an odds ratio of 0.13 (P=0.049).
- Patients receiving vancomycin experienced a significantly shorter onset (5 days vs. 16.7 days) and duration (8.5 days vs. 26.8 days) of infection.
- Pseudomonas aeruginosa was the most common pathogen (35.2%), and patient diagnosis, surgical approach, and blood loss were identified as significant risk factors for SSI.
Conclusions:
- Prophylactic intraoperative vancomycin powder effectively reduces the risk and morbidity of SSI in instrumented spine surgery.
- Pseudomonas aeruginosa infections are prevalent in the vancomycin treatment arm.
- Further prospective randomized controlled trials with larger populations and long-term follow-up are recommended to confirm these findings across various spine surgeries.
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