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Perioperative prophylaxis for surgical site infections in pediatric spinal surgery: a systematic review and network
Annabelle Shaffer1, Anant Naik1, Bailey MacInnis1
11Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Illinois.
Insights
The combination of Betadine and vancomycin is the most effective method for preventing postoperative infections in pediatric spinal surgery. This approach significantly reduces total, deep, and surgical site infections compared to no prophylaxis.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Prevention
- Pediatric Medicine
Background:
- Postoperative infections are a significant concern in pediatric spinal surgery, often requiring reoperation.
- Current pediatric-specific guidelines for infection prophylaxis are lacking.
Approach:
- A systematic review and network meta-analysis of 10 studies involving 5164 procedures was conducted.
- Perioperative prophylaxis methods were compared, including Betadine irrigation, vancomycin powder, combination therapies, and no intervention.
- The primary outcome was the reduction of postoperative infections.
Key Points:
- Betadine plus vancomycin demonstrated the strongest efficacy in reducing total, deep, and surgical site infections.
- Intrawound vancomycin and a combination therapy (Betadine, vancomycin, gentamicin, cefuroxime) also showed significant infection reduction compared to no prophylaxis.
- No treatment-related complications were reported for any of the prophylactic methods.
Conclusions:
- Betadine plus vancomycin is the recommended method for infection prevention in pediatric spinal surgery.
- Despite study heterogeneity, three effective prophylactic treatments were identified.
- Further research may be needed to address outcome reporting inconsistencies.
Objective:
Postoperative infections in pediatric spinal surgery commonly occur and necessitate reoperation(s). However, pediatric-specific infection prophylaxis guidelines are not available. This network meta-analysis compares perioperative prophylaxis methods including Betadine irrigation, saline irrigation, intrawound vancomycin powder, combination therapy (Betadine, vancomycin, gentamicin, and cefuroxime), Betadine irrigation plus vancomycin powder, and no intervention to determine the most efficacious prevention method.
Methods:
A systematic review was performed by searching the PubMed, EBSCO, Scopus, and Web of Science databases for peer-reviewed articles published prior to February 2022 comparing two or more infection prophylaxis methods in patients younger than 22 years of age. Data were extracted for treatment modalities, patient demographics, and patient outcomes such as total number of infections, surgical site infections, deep infections, intraoperative blood loss, operative time, follow-up time, and postoperative complications. Quality and risk of bias was assessed using National Institutes of Health tools. A network meta-analysis was performed with reduction of infections as the primary outcome.
Results:
Overall, 10 studies consisting of 5164 procedures were included. There was no significant difference between prophylactic treatment options in reduction of infection. However, three treatment options showed significant reduction in total infection compared with no prophylactic treatment: Betadine plus vancomycin (OR 0.22, 95% CI 0.09-0.54), vancomycin (OR 3.26, 95% CI 1.96-5.44), and a combination therapy (Betadine, vancomycin, gentamicin, and cefuroxime) (OR 0.24, 95% CI 0.07-0.75). P-Score hierarchical ranking estimated Betadine plus vancomycin to be the superior treatment to prevent total infections, deep infections, and surgical site infections (P-score 0.7876, 0.7175, and 0.7291, respectively). No prophylaxis treatment-related complications were reported.
Conclusions:
The results of this network meta-analysis show the strongest support for Betadine plus vancomycin as a method to reduce infections following pediatric spinal surgery. There was heterogeneity among studies and inconsistent outcome reporting; however, three effective treatment options are identified.
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