Reduction in surgical site infection with suprafascial intrawound application of vancomycin powder in instrumented posterior spinal fusion: a retrospective case-control study.

Haimoto, Shoichi; Schär, Ralph; Nishimura, Yusuke; Hara, Masahito; Wakabayashi, Toshihiko; Ginsberg, Howard J (2018). Reduction in surgical site infection with suprafascial intrawound application of vancomycin powder in instrumented posterior spinal fusion: a retrospective case-control study. Journal of neurosurgery - spine, 29(2), pp. 193-198. American Association of Neurological Surgeons 10.3171/2017.12.SPINE17997

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OBJECTIVE Recent studies have demonstrated the efficacy of subfascial intrawound application of vancomycin powder in spine surgery in reducing the rate of surgical site infections (SSIs). However, to date no study has evaluated the efficacy and safety of suprafascial application of vancomycin powder in spine surgery. The purpose of this study was to quantify the rate of SSIs after open instrumented posterior spinal fusion with and without application of suprafascial vancomycin powder and to evaluate the rate of vancomycin powder-related local adverse effects. METHODS The authors conducted a single-center retrospective case-control study of adult patients undergoing open instrumented posterior fusion of the cervical, thoracic, or lumbar spine performed by a single surgeon from January 2010 through December 2016. In March 2013, routine application of 1 g of suprafascial vancomycin powder was started for all cases in addition to standard systemic antibiotic prophylaxis. Baseline demographics and operative data as well as the SSI rates were compared between the study groups. The incidence of vancomycin powder-related adverse effects was analyzed. RESULTS A total of 515 patients (268 in the untreated group and 247 in the treated group) were included in the study. The mean age was significantly higher in the treated group than in the untreated group (58.4 vs 54.4 years, p < 0.01). Operative variables were similar between the study groups. Patients receiving vancomycin powder had a significantly lower infection rate (5.6% in the untreated group vs 0% in the treated group, p < 0.001). No vancomycin powder-related adverse effects were identified in the treated group. CONCLUSIONS Routine application of suprafascial intrawound vancomycin powder in addition to systemic antibiotic prophylaxis is an easy-to-use, safe, and effective strategy for preventing SSIs after instrumented posterior spinal fusion. Suprafascial application of vancomycin powder could be a valuable alternative to previously reported subfascial distribution, minimizing the risk of local adverse drug reactions.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Schär, Ralph

Subjects:

600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology

ISSN:

1547-5654

Publisher:

American Association of Neurological Surgeons

Language:

English

Submitter:

Ralph Schär

Date Deposited:

16 Jul 2018 15:38

Last Modified:

03 Aug 2018 01:32

Publisher DOI:

10.3171/2017.12.SPINE17997

PubMed ID:

29726801

Uncontrolled Keywords:

ASA = American Society of Anesthesiologists CSF = cerebrospinal fluid DBM = demineralized bone matrix IV = intravenous SSI = surgical site infection adverse drug reaction posterior spinal fusion spine surgery suprafascial application surgical site infection vancomycin powder

URI:

https://boris.unibe.ch/id/eprint/118541

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