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Published on: March 14, 2019
Vancomycin powder mixed with autogenous bone graft and bone substitute may decrease the deep surgical site infections
Shih-Tien Wang1, Hsi-Hsien Lin2, Yu-Cheng Yao2
1School of Medicine, National Yang-Ming Chiao-Tung University. No.155, Sec.2, Linong Street, Taipei, 112 Taiwan; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, Taiwan 11217; Kinmen Hospital, Ministry of Health and Welfare. No.2, Fuxing Rd., Jinhu Township, Kinmen County 891, Taiwan; Institute of Hospital and Health care administration, School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 112 Taiwan.
Intraoperative vancomycin powder (VP) mixed with bone graft effectively prevents deep surgical site infections (DSSI) in lumbar fusion surgery. This approach is safe and does not impact bone fusion rates, particularly benefiting diabetic patients.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Prevention
- Spinal Fusion Techniques
Background:
- Deep surgical site infections (DSSI) pose significant risks following lumbar instrumented fusion.
- Intraoperative vancomycin powder (VP) is used for DSSI prevention, but its efficacy with bone grafts is unclear.
Purpose of the Study:
- To evaluate the impact of vancomycin powder mixed with autogenous bone graft (ABG) and bone substitute on DSSI rates and bone fusion.
- To assess the safety and efficacy of this combination in lumbar degenerative fusion surgery.
Main Methods:
- Prospective randomized controlled study (NCT03883022) involving 705 adult patients undergoing lumbar instrumented fusion.
- Patients were randomized into vancomycin (n=357) or control (n=348) groups.
- Primary outcome: DSSI within 90 days; secondary outcomes: complications, functional scores (ODI, VAS), and bone fusion (radiographs, Lenke, BSF criteria).
Main Results:
- No DSSIs occurred in the vancomycin group versus five (1.4%) in the control group (p=.029).
- Diabetic patients in the vancomycin group had zero DSSIs (0/119) compared to the control group (5/105, p=.021).
- No vancomycin-related complications were observed; functional outcomes and bone fusion rates were similar between groups.
Conclusions:
- Vancomycin powder combined with ABG and bone substitute is safe and effective for preventing DSSI in lumbar fusion.
- This strategy maintains adequate surgical site antibiotic levels without compromising bony fusion.
- The findings are particularly relevant for diabetic patients undergoing lumbar fusion surgery.
