scholarly journals PROPHYLAXIS OF SURGICAL SITE INFECTION WITH VANCOMYCIN IN 513 PATIENTS THAT UNDERWENT TO LUMBAR FUSION

2015 ◽  
Vol 14 (3) ◽  
pp. 177-180 ◽  
Author(s):  
Nicolas Scheverin ◽  
Alejandro Steverlynck ◽  
Roberto Castelli ◽  
Diego Sobrero ◽  
Nicolas Videla Kopp ◽  
...  
Keyword(s):  
Bone Graft ◽  
Spinal Fusion ◽  
Statistical Difference ◽  
Lumbar Fusion ◽  
Posterior Spinal Fusion ◽  
Control Group ◽  
Site Infection ◽  
Intravenous Antibiotic ◽  
Skin Preparation ◽  
Vancomycin Group

Objective:To assess the prophylactic effects of local vancomycin on an infection of the surgical site in patients undergoing lumbar instrumented fusion.Methods:Retrospective study from January 2011 to June 2014 in patients with symptomatic and refractory lumbar spine stenosis and listhesis who underwent instrumented pedicle screw spinal fusion. Two groups of patient were analyzed, one using vancomycin on the surgical site, vancomycin group (VG) and the control group (CG) without topical vancomycin. The routine prophylactic procedures were performed in both groups: aseptic scrub technique, skin preparation, preoperative intravenous antibiotic therapy. The VG received a dose of 1g of vancomycin mixed with the bone graft every three spinal levels fused and the group consisted of 232 patients.Results:513 patients were analyzed, 232 in the VG and 281 in the CG. There was no statistical difference between the groups when the sex, mean surgery length, and mean bleeding volume were considered. The rate of infection for VG was reduced from 4.98% to 1.29% when compared with CG.Conclusion:The use of vancomycin added to the bone graft in posterior spinal fusion is associated with significantly lower rates of infection.

scholarly journals The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery

2017 ◽  
Vol 26 (5) ◽  
pp. 645-649 ◽  
Author(s):  
Anuj Singla ◽  
Scott Yang ◽  
Brian C. Werner ◽  
Jourdan M. Cancienne ◽  
Ali Nourbakhsh ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Postoperative Infection ◽  
Lumbar Fusion ◽  
Posterior Spinal Fusion ◽  
Infection Risk ◽  
Site Infection ◽  
Lumbar Spinal Fusion ◽  
Epidural Injections ◽  
Lumbar Spinal ◽  
Insurance Database

OBJECTIVELumbar epidural steroid injections (LESIs) are performed for both diagnostic and therapeutic purposes for a variety of indications, including low-back pain, the leading cause of disability and expense due to work-related conditions in the US. The steroid agent used in epidural injections is reported to relieve nerve root inflammation, local ischemia, and resultant pain, but the injection may also have an adverse impact on spinal surgery performed thereafter. In particular, the possibility that preoperative epidural injections may increase the risk of surgical site infection after lumbar spinal fusion has been reported but has not been studied in detail. The goal of the present study was to use a large national insurance database to analyze the association of preoperative LESIs with surgical site infection after lumbar spinal fusion.METHODSA nationwide insurance database of patient records was used for this retrospective analysis. Current Procedural Terminology codes were used to query the database for patients who had undergone LESI and 1- or 2-level lumbar posterior spinal fusion procedures. The rate of postoperative infection after 1- or 2-level posterior spinal fusion was analyzed. These study patients were then divided into 3 separate cohorts: 1) lumbar spinal fusion performed within 1 month after LESI, 2) fusion performed between 1 and 3 months after LESI, and 3) fusion performed between 3 and 6 months after LESI. The study patients were compared with a control cohort of patients who underwent lumbar fusion without previous LESI.RESULTSThe overall 3-month infection rate after lumbar spinal fusion procedure was 1.6% (1411 of 88,540 patients). The infection risk increased in patients who received LESI within 1 month (OR 2.6, p < 0.0001) or 1–3 months (OR 1.4, p = 0.0002) prior to surgery compared with controls. The infection risk was not significantly different from controls in patients who underwent lumbar fusion more than 3 months after LESI.CONCLUSIONSLumbar spinal fusion performed within 3 months after LESI may be associated with an increased rate of postoperative infection. This association was not found when lumbar fusion was performed more than 3 months after LESI.

Effect of Preoperative Skin Preparation Methods on Sternotomy Surgical Site Infection Rates: A Quasi-Experimental Study

2021 ◽  
Vol 67 (10) ◽  
pp. 28-39
Author(s):  
Ebru Karazeybek ◽  
Sevilay Şenol Çelik ◽  
Ozan Erbasan
Keyword(s):  
Experimental Study ◽  
Surgical Site Infection ◽  
Medical History ◽  
Control Group ◽  
Site Infection ◽  
Body Hair ◽  
Skin Preparation ◽  
Preparation Methods ◽  
Patient Demographic ◽  
Quasi Experimental

BACKGROUND: A surgical site infection (SSI) reduces patient quality of life, increases morbidity and mortality rates, and increases health care costs. Results of studies comparing the effects of preoperative skin preparations are contradictory. PURPOSE: This study aimed to determine the effect of different preoperative skin preparation methods on the rate of SSIs in patients undergoing sternotomy. METHODS: A quasi-experimental study was conducted among 96 male patients undergoing sternotomy. The control group (CG) (n = 34) received routine care consisting of shaving body hair with a razor blade followed by instructions to take a bath or shower. In the intervention groups, patients received education about SSI prevention and body hair was removed with an electric clipper, followed by bathing with daphne soap containing olive oil (IG-1) (n = 31) or 2% chlorhexidine solution (IG-2) (n = 31). Patient demographic, medical history, surgical, and wound assessment variables were obtained. Potential SSI signs and symptoms were assessed for up to 90 days following surgery. RESULTS: Patient demographic, medical history, and surgical variables did not differ among the 3 groups. Sternal SSI occurred in 10.4% of all study patients; 8.8% of the CG patients, 12.9% of the IG-1 patients, and 9.7% of the IG-2 patients developed an SSI (P > .05). CONCLUSION: There were no significant differences in the rate of sternotomy SSI among the 3 groups. Randomized controlled trials with large samples are needed to compare these methods to determine optimal and affordable preoperative skin preparation methods.

Collagen/ β -TCP composite as a bone-graft substitute for posterior spinal fusion in rabbit model: a comparison study

2019 ◽  
Vol 14 (4) ◽  
pp. 045009 ◽  
Author(s):  
Yajie Lu ◽  
Minghui Li ◽  
Zuoyao Long ◽  
Di Yang ◽  
Shuo Guo ◽  
...  
Keyword(s):  
Bone Graft ◽  
Spinal Fusion ◽  
Rabbit Model ◽  
Posterior Spinal Fusion ◽  
Bone Graft Substitute ◽  
Comparison Study

scholarly journals Rib bone graft for posterior spinal fusion in children

2002 ◽  
Vol 73 (6) ◽  
pp. 709-711
Author(s):  
Jon Berg-Johnsen ◽  
Bjørn Magnæes
Keyword(s):  
Bone Graft ◽  
Spinal Fusion ◽  
Posterior Spinal Fusion

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

2013 ◽  
Vol 19 (3) ◽  
pp. 331-335 ◽  
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.

Rib bone graft for posterior spinal fusion in children

2002 ◽  
Vol 73 (6) ◽  
pp. 709-711
Author(s):  
Jon Berg-Johnsen ◽  
Bjørn Magnæs
Keyword(s):  
Bone Graft ◽  
Spinal Fusion ◽  
Posterior Spinal Fusion

Can Basic Fibroblast Growth Factor Pre-Treatment Enhance Mesenchymal Stem Cell Therapy in Undecorticated Posterior Spinal Fusion?

2007 ◽  
Vol 330-332 ◽  
pp. 1137-1140
Author(s):  
Chan Wai Chan ◽  
K.H.K. Wong ◽  
K.M. Lee ◽  
Ling Qin ◽  
H.Y. Yeung ◽  
...  
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Mesenchymal Stem Cells ◽  
Stem Cell ◽  
Growth Factor ◽  
Spinal Fusion ◽  
Xylenol Orange ◽  
Posterior Spinal Fusion ◽  
Control Group ◽  
Fibroblast Growth

Basic fibroblast growth factor (bFGF) has been shown to maintain the osteogenicity of bone marrow derived mesenchymal stem cell (MSCs) in vitro. This study was to investigate whether bFGF with osteogenic supplements could enhance bone formation of posterior spinal fusion. Rabbit bone marrow derived mesenchymal stem cells were selected by adherence on plastic culture-ware. The MSCs were exposed to dexamethasone with (bFGF group, n=6) or without bFGF (OS group, n=6). Treated cells of two groups were seeded on β-tricalcium phosphate ceramics for one day and then implanted onto L5 and L6 transverse processes of the same animal in posterior spinal fusion without decortication. The ceramics acted as control (n=6). Three fluorochromes were injected sequentially as tetracycline at week 2, xylenol orange at week 4 and calcein at week 6. The spinal segments were harvested at week 7. The bone mineral content (BMC) and volume of transverse processes was measured by peripheral quantitative computed tomography. The specimens were underwent undecalcified histology. The mineralization process was examined by fluorescent microscopy. The BMC of transverse processes in OS group was 16% greater than bFGF and control group significantly. The volume of transverse process in OS and bFGF group was significantly greater than control group by 54% and 46% respectively. The volume of transverse processes in OS group was 6% greater than bFGF group though not statistically significant. In histology, newly formed bone grew from two processes towards each other resulting in a relatively short gap distance in OS and bFGF group while less regenerated bone was observed in the control group. At the mineralization front, calcein which was injected into animal at week 6, was predominately labeled in bFGF group. In OS group, both xylenol orange (at week 4) and calcein labeled were found. In conclusion, mesenchymal stem cells pre-exposed to bFGF were not found to give additional enhancement effect on bone formation in the posterior spinal fusion model.

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