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Post-Operative Infection Following Multi-Level Posterior Lumbar Spinal Instrumentation in the Vancomycin Powder Era
Janesh Karnati1,2, Sruthi Ranganathan1,2, Xu Tao1,2
1Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati Ohio, USA.
Abstract:
Background: Since the early 2010s, prophylactic vancomycin powder has been widely adopted in spine surgery, with many surgeons crediting it for low surgical site infection (SSI) rates (1%-2%). However, its efficacy remains debated. Purpose: To compare post-operative SSI and related complications in multi-level posterior lumbar spinal surgery before and after the widespread use of vancomycin powder. Design: Retrospective study using the TriNetX Research Network. Patient Sample: Adult patients undergoing posterior spinal instrumentation (≥3 levels) for lumbar stenosis or spondylolisthesis. Outcome Measures: Primary: Composite rate of post-operative infections (superficial/deep incisional SSI, organ/space SSI, sepsis). Secondary: Incidence of incision and drainage (I&D) for SSIs. Methods: Patients were divided into two cohorts: 2003-2013 (pre-vancomycin era) and 2014-2023 (vancomycin era). Propensity matching was controlled for age, gender, race, and comorbidities. Post-operative infections requiring I&D within 90 days were identified using procedural and diagnostic codes. Results: Of 33,320 patients (mean age: 63.6 y; 43.3% male), 28,649 (86.0%) underwent surgery in 2014-2023 and 4,671 (14.0%) in 2003-2013. After propensity matching (4,668 patients per cohort), the 2014-2023 group had significantly lower odds of requiring I&D (odds ratio [OR] = 0.337) and developing post-operative infections (OR = 0.606). Conclusion: This large-scale, propensity-matched analysis suggests that the likelihood of post-operative infections or requiring I&D following multi-level posterior lumbar spinal instrumentation is approximately 40%-60% lower in the vancomycin era compared with the pre-vancomycin period.
Insights
Prophylactic vancomycin powder use in spine surgery significantly reduced surgical site infections (SSIs) and the need for incision and drainage (I&D) by 40%-60%. This large study compared multi-level posterior lumbar surgery outcomes before and after vancomycin powder became common practice.
Area of Science:
- Orthopedics
- Neurosurgery
- Infectious Disease
Background:
- Prophylactic vancomycin powder is widely used in spine surgery since the early 2010s, with reported surgical site infection (SSI) rates of 1%-2%.
- The actual efficacy of vancomycin powder in preventing SSIs in multi-level posterior lumbar spinal surgery remains a subject of debate.
Purpose of the Study:
- To compare the rates of post-operative SSIs and associated complications in patients undergoing multi-level posterior lumbar spinal surgery.
- To evaluate the impact of prophylactic vancomycin powder use on SSI rates and the need for surgical intervention (incision and drainage).
Main Methods:
- A retrospective study utilizing the TriNetX Research Network analyzed adult patients who underwent posterior spinal instrumentation (≥3 levels) for lumbar stenosis or spondylolisthesis.
- Patients were divided into two cohorts: pre-vancomycin era (2003-2013) and vancomycin era (2014-2023).
- Propensity matching controlled for age, gender, race, and comorbidities. Post-operative infections requiring incision and drainage (I&D) within 90 days were identified.
Main Results:
- The study included 33,320 patients; 14.0% were from the pre-vancomycin era and 86.0% from the vancomycin era.
- After propensity matching (4,668 patients per cohort), the vancomycin era group showed significantly lower odds of requiring I&D (OR=0.337) and developing post-operative infections (OR=0.606).
- The likelihood of post-operative infections or requiring I&D was approximately 40%-60% lower in the vancomycin era.
Conclusions:
- This large-scale, propensity-matched analysis indicates a substantial reduction in post-operative infections and the need for I&D following multi-level posterior lumbar spinal instrumentation.
- The findings suggest that the widespread adoption of vancomycin powder is associated with improved outcomes in preventing SSIs in this patient population.
