Measures to reduce end-of-case wound contamination: the impact of intra-wound vancomycin powder and betadine irrigation on surgical site infections in posterior spinal fusion

Abstract BACKGROUND The impact of vancomycin powder on reducing postoperative surgical site infections (SSIs) in spine surgery has been studied extensively and is considered standard of care at many institutions. More recently, vancomycin powder has been shown to reduce SSI in cranial neurosurgery; however, limited studies have been performed assessing its impact in reducing SSIs in deep brain stimulation (DBS) surgery. OBJECTIVE To investigate the use of vancomycin powder as an adjunct to the current antibiotic prophylaxis regimen in DBS surgery in a large cohort of patients. METHODS All patients undergoing DBS-lead implantation surgery and chest generator placement or exchange were analyzed prior to and after the implementation of intrawound vancomycin powder, and the impact on infection rate and any complications were subsequently examined. RESULTS From 2015 to 2017, a total of 419 consecutive patients (159 in the pretreatment group, 260 in the post-treatment group) were included in the study. The rate of SSI prior to implementation of intrawound vancomycin was 3.1% (n = 5), which was reduced to 0.38% (n = 1) in the post-treatment group. No complications were noted as a direct result of using vancomycin powder. CONCLUSION Given its relatively low cost and side effect profile, the use of vancomycin powder may be an effective adjunct in reducing the rate of SSI in DBS surgery.

Download Full-text

Comparative effectiveness and cost-benefit analysis of local application of vancomycin powder in posterior spinal fusion for spine trauma

Journal of Neurosurgery Spine ◽

10.3171/2013.6.spine121105 ◽

2013 ◽

Vol 19 (3) ◽

pp. 331-335 ◽

Cited By ~ 111

Author(s):

Saniya S. Godil ◽

Scott L. Parker ◽

Kevin R. O'Neill ◽

Clinton J. Devin ◽

Matthew J. McGirt

Keyword(s):

Treatment Group ◽

Spinal Fusion ◽

Postoperative Infection ◽

Cost Savings ◽

Cost Benefit ◽

Posterior Spinal Fusion ◽

Control Group ◽

Spine Trauma ◽

Postoperative Infections ◽

Vancomycin Powder

Object Surgical site infection (SSI) is a morbid complication with high cost in spine surgery. In this era of health care reforms, adjuvant therapies that not only improve quality but also decrease cost are considered of highest value. The authors introduced local application of vancomycin powder into their practice of posterior spinal fusion for spine trauma and undertook this study to determine the value and cost benefit of using vancomycin powder in surgical sites to prevent postoperative infections. Methods A retrospective review of 110 patients with traumatic spine injuries treated with instrumented posterior spine fusions over a 2-year period at a single institution was performed. One group (control group) received standard systemic prophylaxis only, whereas another (treatment group) received 1 g of locally applied vancomycin powder (spread over the surgical wound) in addition to systemic prophylaxis. Data were collected on patient demographic characteristics, clinical variables, surgical variables, and 90-day morbidity. Incidence of infection was the primary outcome evaluated, and billing records were reviewed to determine total infection-related medical cost (cost of reoperation/wound debridement, medications, and diagnostic tests). The payer's cost was estimated to be 70% of the total billing cost. Results A total of 110 patients were included in the study. The control (n = 54) and treatment groups (n = 56) were similar at baseline. Use of vancomycin powder led to significant reduction in infection rate (13% infection rate in the control group vs 0% in the treatment group, p = 0.02). There were no adverse effects noted from the use of vancomycin powder. The total mean cost of treating postoperative infection per patient was $33,705. Use of vancomycin powder led to a cost savings of $438,165 per 100 posterior spinal fusions performed for traumatic injuries. Conclusions The use of adjuvant vancomycin powder was associated with a significant reduction in the incidence of postoperative infection as well as infection-related medical cost. These findings suggest that use of adjuvant vancomycin powder in high-risk patients undergoing spinal fusion is a cost-saving option for preventing postoperative infections, as it can lead to cost-savings of $438,165 per 100 spinal fusions performed.

Download Full-text

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 ◽

10.3171/2017.12.spine17997 ◽

2018 ◽

Vol 29 (2) ◽

pp. 193-198 ◽

Cited By ~ 17

Author(s):

Shoichi Haimoto ◽

Ralph T. Schär ◽

Yusuke Nishimura ◽

Masahito Hara ◽

Toshihiko Wakabayashi ◽

...

Keyword(s):

Adverse Effects ◽

Spinal Fusion ◽

Case Control Study ◽

Posterior Spinal Fusion ◽

Study Groups ◽

Treated Group ◽

Untreated Group ◽

Retrospective Case ◽

Vancomycin Powder ◽

Control Study

OBJECTIVERecent 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.METHODSThe 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.RESULTSA 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.CONCLUSIONSRoutine 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.

Download Full-text

The Impact of Body Mass Index (BMI) on 30-day Outcomes Following Posterior Spinal Fusion in Neuromuscular Scoliosis

Spine ◽

10.1097/brs.0000000000003084 ◽

2019 ◽

Vol 44 (19) ◽

pp. 1348-1355

Author(s):

Azeem Tariq Malik ◽

Robert Tamer ◽

Elizabeth Yu ◽

Jeffery Kim ◽

Safdar N. Khan

Keyword(s):

Body Mass Index ◽

Spinal Fusion ◽

Body Mass ◽

Posterior Spinal Fusion ◽

Neuromuscular Scoliosis ◽

The Impact

Download Full-text

The Impact of Vancomycin and Cefazolin as Standard Preoperative Antibiotic Prophylaxis on Surgical Site Infections Following Instrumented Spinal Fusion

Spine ◽

10.1097/brs.0000000000002839 ◽

2019 ◽

Vol 44 (6) ◽

pp. E366-E371 ◽

Cited By ~ 6

Author(s):

Wylie Y. Lopez ◽

Sean M. Rider ◽

Kenneth Nwosu ◽

Erick R. Kazarian ◽

Justin A. Blucher ◽

...

Keyword(s):

Antibiotic Prophylaxis ◽

Spinal Fusion ◽

Surgical Site Infections ◽

Preoperative Antibiotic Prophylaxis ◽

The Impact

Download Full-text

Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Global Spine Journal ◽

10.1177/2192568220935107 ◽

2020 ◽

pp. 219256822093510

Author(s):

Yoji Ogura ◽

Steven D. Glassman ◽

Daniel Sucato ◽

M. Timothy Hresko ◽

Leah Y. Carreon

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Pedicle Screw ◽

Standard Procedure ◽

Pedicle Screws ◽

Posterior Spinal Fusion ◽

Proximal Junctional Kyphosis ◽

The Impact ◽

Junctional Kyphosis

Study Design: Longitudinal cohort. Objectives: Posterior spinal fusion (PSF) using all-pedicle screw constructs has become the standard procedure in the treatment of adolescent idiopathic scoliosis (AIS). However, there have been several reports that all-pedicle screw constructs or the use of pedicle screws at the upper instrumented vertebrae (UIV) increases the incidence of proximal junctional kyphosis (PJK). We aimed to evaluate the impact of instrumentation type on the incidence of PJK following PSF for AIS. Methods: We performed a stratified random sampling from 3654 patients enrolled in a multicenter database of surgically treated AIS to obtain a representative sample from all Lenke types. Patients were then allocated into 3 groups based on the instrumentation type: all-pedicle screw (PS), hook at UIV with pedicle screws distally (HT), and hybrid constructs (HB). We measured proximal junctional angle (PJA) and defined PJK as PJA ≥ 10° and PJA progression of >10° at the final follow-up. Results: Fifteen (4.3%) of 345 cases had PJK. PJK was significantly more common in PS (11%) compared with HB (1%) and HT (0%) ( P < .001). PJK patients were similar to non-PJK patients regarding age, sex, curve type, UIV, and preoperative coronal Cobb angle. Thoracic kyphosis was significantly higher in the PJK group before surgery. Patients who developed PJK had a statistically significantly larger negative sagittal balance compared with the non-PJK group. Conclusion: The incidence of PJK was 4.3% and was more common in all-pedicle screw constructs. Using hooks at UIV might be a treatment strategy to limit PJK.

Download Full-text

Effect of body mass index on surgical outcomes after posterior spinal fusion for adolescent idiopathic scoliosis

Neurosurgical FOCUS ◽

10.3171/2017.7.focus17342 ◽

2017 ◽

Vol 43 (4) ◽

pp. E5 ◽

Cited By ~ 13

Author(s):

Rafael De la Garza Ramos ◽

Jonathan Nakhla ◽

Rani Nasser ◽

Jacob F. Schulz ◽

Taylor E. Purvis ◽

...

Keyword(s):

Body Mass Index ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Body Mass ◽

Complication Rate ◽

Posterior Spinal Fusion ◽

Reoperation Rate ◽

Health Concern ◽

The Impact

OBJECTIVEObesity is an increasing public health concern in the pediatric population. The purpose of this investigation was to examine the impact of body mass index (BMI) on 30-day outcomes after posterior spinal fusion for adolescent idiopathic scoliosis (AIS).METHODSThe American College of Surgeons National Surgical Quality Improvement Program Pediatric database (2013 and 2014) was reviewed. Patients 10–18 years of age who had undergone fusion of 7 or more spinal levels for AIS were included. Thirty-day outcomes (complications, readmissions, and reoperations) were compared based on patient BMI per age- and sex-adjusted growth charts as follows: normal weight (NW; BMI < 85th percentile), overweight (OW; BMI 85th–95th percentile), and obese (OB; BMI > 95th percentile).RESULTSPatients eligible for study numbered 2712 (80.1% female and 19.9% male) and had a mean age of 14.4 ± 1.8 years. Average BMI for the entire cohort was 21.9 ± 5.0 kg/m2; 2010 patients (74.1%) were classified as NW, 345 (12.7%) as OW, and 357 (13.2%) as OB. The overall complication rate was 1.3% (36/2712). For NW and OW patients, the complication rate was 0.9% in each group; for OB patients, the rate was 4.2% (p < 0.001). The 30-day readmission rate was 2.0% (55/2712) for all patients, 1.6% for NW patients, 1.2% for OW patients, and 5.0% for OB patients (p < 0.001). The 30-day reoperation rate was 1.4% (39/2712). Based on BMI, this reoperation rate corresponded to 0.9%, 1.2%, and 4.8% for NW, OW, and OB patients, respectively (p < 0.001). After controlling for patient age, number of spinal levels fused, and operative/anesthesia time on multiple logistic regression analysis, obesity remained a significant risk factor for complications (OR 4.61), readmissions (OR 3.16), and reoperations (OR 5.33; all p < 0.001).CONCLUSIONSBody mass index may be significantly associated with short-term outcomes after long-segment fusion procedures for AIS. Although NW and OW patients may have similar 30-day outcomes, OB patients had significantly higher wound complication, readmission, and reoperation rates and longer hospital stays than the NW patients. The findings of this study may help spine surgeons and patients in terms of preoperative risk stratification and perioperative expectations.

Download Full-text