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Intrawound Vancomycin Powder Associated With Reduced Surgical Site Infection in Rib-based Distraction Surgery
Justin M Haller1, John A Heflin2, David A Hulet1
1Department of Orthopaedics.
Background:
Despite clinical reports of improved pulmonary function and reduced spinal deformity with rib-based distraction surgery in early-onset scoliosis (EOS) patients, infection remains a common complication, reported as high as 32% in some studies. The purpose of this study was to evaluate intrawound vancomycin powder in pediatric patients managed with rib-based distraction for EOS.
Methods:
This was a single institution retrospective cohort study of EOS patients treated with rib-based distraction. Patients treated with and without intrawound vancomycin were compared. Patients included were younger than 18 years of age, had undergone placement of a rib-based distraction construct, and had a minimum of 6 months' follow-up. For patients in the vancomycin group, 500 mg of vancomycin powder was placed before wound closure. Complications including infection and revision surgery were recorded. P-values and 95% confidence intervals (CIs) were reported for both unadjusted and adjusted complication rates for prevancomycin and postvancomycin powder. All P-values were calculated at a significance level of 0.05.
Results:
In total, 118 patients were included, accounting for 1035 procedures in the nonvancomycin control group and 252 procedures in the vancomycin group. Both groups were similar with regard to age at initial implant, sex, diagnosis, ambulatory status, and bowel/bladder incontinence. There were 55 (5.3%; 95% CI, 4.1-7.6) postoperative infections in the control group and 3 (1.2%; 95% CI, 0.3-3.8) in the vancomycin group (P=0.008, unadjusted). After adjusting for surgery type and transfusions, the vancomycin group still had a significantly lower infection rate (1.4%; 95% CI, 0.3-3.7 vs. 5.5%; 95% CI, 3.04-6.5; P=0.022). We were unable to demonstrate a difference between the control (3.5%, 95% CI, 2.4-5.1) and vancomycin (1.8%, 95% CI, 0.5-5.7) groups for deep infection (P=0.27).
Conclusions:
Intrawound vancomycin powder significantly reduced the surgical site infection rates following rib-based distraction surgery for EOS. We therefore recommend the use of intrawound vancomycin powder as a standard of care for patients undergoing rib-based distraction surgery.
Level Of Evidence:
Pre-post intervention, retrospective cohort study-therapeutic level III.
Insights
Intrawound vancomycin powder significantly reduced surgical site infections in early-onset scoliosis (EOS) patients undergoing rib-based distraction surgery. This study recommends its use as a standard of care to improve patient outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Surgery
- Infectious Disease Prevention
Background:
- Early-onset scoliosis (EOS) patients undergoing rib-based distraction surgery face high complication rates, particularly surgical site infections (SSIs), reported up to 32%.
- Optimizing surgical techniques and prophylactic measures is crucial for improving outcomes in pediatric spinal deformity correction.
Purpose of the Study:
- To evaluate the efficacy of intrawound vancomycin powder in reducing SSIs in pediatric patients undergoing rib-based distraction for EOS.
- To compare infection rates between patients treated with and without intrawound vancomycin.
Main Methods:
- Retrospective cohort study involving pediatric EOS patients treated with rib-based distraction.
- Comparison of infection and revision surgery rates between a control group (no vancomycin) and a vancomycin group (500 mg intrawound powder).
- Statistical analysis included P-values and 95% confidence intervals for unadjusted and adjusted complication rates.
Main Results:
- A total of 118 patients and 1287 procedures were analyzed (1035 non-vancomycin, 252 vancomycin).
- The vancomycin group showed a significantly lower overall infection rate (1.2%) compared to the control group (5.3%) (P=0.008 unadjusted, P=0.022 adjusted).
- No significant difference was found in deep infection rates between the groups (1.8% vancomycin vs. 3.5% control, P=0.27).
Conclusions:
- Intrawound vancomycin powder is effective in significantly reducing surgical site infection rates after rib-based distraction surgery for EOS.
- The findings support the implementation of intrawound vancomycin powder as a standard prophylactic measure in these procedures.
- This approach can contribute to improved patient safety and reduced complications in pediatric spinal deformity surgery.
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