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Application of Bayesian Methods to Help Interpret the VANCO Trial Results
Nathan N O'Hara1, Renan C Castillo2, Anthony R Carlini2
1Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
Journal of Orthopaedic Trauma
|July 13, 2022
Summary
Bayesian analysis confirms intrawound vancomycin powder significantly reduces deep surgical site infections, especially gram-positive ones, in high-risk fracture patients. The probability of this benefit is over 98%.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Biostatistics
Background:
- Deep surgical site infections (SSIs) are a significant complication in patients with high-risk tibial plateau or pilon fractures.
- Topical antibiotics are explored as a strategy to mitigate SSI risk following definitive fracture fixation.
Purpose of the Study:
- To conduct a secondary analysis of the VANCO trial using Bayesian methods.
- To determine the impact of Bayesian analysis on the trial's outcomes regarding intrawound vancomycin powder efficacy.
Main Methods:
- A secondary Bayesian analysis was performed on data from a randomized clinical trial involving 980 patients across 36 US trauma centers.
- Patients received either 1000 mg of intrawound vancomycin powder or no topical antibiotics during definitive plate and screw fixation for tibial plateau or pilon fractures.
- The primary outcome was deep SSI requiring operative treatment within 6 months; secondary outcomes included gram-positive and gram-negative SSIs.
Main Results:
- The Bayesian analysis estimated a >98% probability that intrawound vancomycin powder reduces the risk of deep SSI (Relative Risk [RR], 0.66; 95% Credible Interval [CrI], 0.46-0.98).
- There is a >99% probability that intrawound vancomycin powder reduces gram-positive SSIs (RR, 0.52; 95% CrI, 0.33-0.84).
- The analysis indicated a 44% probability that intrawound vancomycin powder prevents gram-negative SSIs (RR, 1.06; 95% CrI, 0.48-2.45).
Conclusions:
- Intrawound vancomycin powder demonstrates a high probability (>98%) of reducing deep surgical site infections in high-risk fracture patients.
- The efficacy of intrawound vancomycin powder is particularly pronounced for gram-positive deep SSIs, with a probability exceeding 99%.
- The use of intrawound vancomycin powder is unlikely to prevent gram-negative surgical site infections.
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