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Does intrawound vancomycin powder reduce surgical site infection after posterior instrumented spinal surgery? A
Chiaki Horii1, Takashi Yamazaki2, Hiroyuki Oka3
1Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 113-8655, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan.
Background Context:
Recent reports suggested that placing vancomycin powder into surgical wounds before closure can prevent surgical site infections (SSIs) in spinal surgery.
Purpose:
The present study aimed to evaluate if intrawound vancomycin powder could prevent SSIs after spinal surgery with posterior instrumentation.
Study Design:
This is a multicenter retrospective cohort study using propensity score matching.
Patient Sample:
We reviewed all spinal surgeries performed with posterior instrumentation from July 2012 to December 2014 at 11 institutions among patients aged ≥15 years.
Outcome Measures:
The incidence of SSIs was compared between patients who received intrawound vancomycin powder (vancomycin group) and those who did not (control group).
Methods:
Demographic and operative data and microbiological findings of SSI cases were analyzed. After a preliminary whole-cohort analysis, we performed one-to-one propensity score matching to adjust for the differences between the two groups and then compared the incidence of SSIs between the matched groups. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
Results:
A total of 2,859 patients were included in the study. In the vancomycin and control groups (n=694 and n=2165, respectively), 12 (1.73%) and 21 (0.97%) patients developed SSIs, respectively, but the difference was not statistically significant (p=.10, chi-square test). During the propensity score-matched analysis, 507 pairs were analyzed. No significant change in the rate of SSIs was seen between the vancomycin and control groups (8 SSIs [1.58%] vs. 9 SSIs [1.78%], respectively; p=.81, chi-square test). Microbiological analysis revealed that 5 of 12 (42%) and 11 of 21 (52%) SSIs in the vancomycin and control groups, respectively, were caused by Staphylococcus (p=.72, Fisher exact test).
Conclusions:
Intrawound application of vancomycin powder was not associated with a significant decrease in the incidence of SSIs after posterior instrumented spinal surgeries in a propensity score-matched analysis. However, the rate of infections caused by Staphylococcus species was lower in the vancomycin group.
Insights
Intrawound vancomycin powder did not significantly reduce surgical site infections (SSIs) in spinal surgery. However, it showed a trend toward lower Staphylococcus infections, warranting further investigation for SSI prevention.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Prevention
- Pharmacology
Background:
- Surgical site infections (SSIs) are a concern in spinal surgery.
- Intrawound vancomycin powder is increasingly considered for SSI prevention.
- Evidence for its efficacy in posterior instrumented spinal surgery is limited.
Purpose of the Study:
- To evaluate the effectiveness of intrawound vancomycin powder in preventing SSIs.
- To assess its impact on spinal surgery with posterior instrumentation.
- To analyze microbiological data of SSIs.
Main Methods:
- Multicenter retrospective cohort study.
- Propensity score matching for statistical analysis.
- Comparison of SSI incidence between vancomycin and control groups.
Main Results:
- No statistically significant difference in overall SSI rates between groups (1.73% vs. 0.97%, p=.10).
- Matched analysis also showed no significant difference (1.58% vs. 1.78%, p=.81).
- A lower proportion of Staphylococcus infections was observed in the vancomycin group (42% vs. 52%).
Conclusions:
- Intrawound vancomycin powder was not associated with a significant decrease in SSIs after posterior instrumented spinal surgery.
- The study suggests a potential trend towards reduced Staphylococcus infections.
- Further research may be needed to clarify the role of vancomycin in specific SSI prevention contexts.
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