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.

scholarly journals The Use of Vancomycin Powder for Surgical Prophylaxis Following Craniotomy

Neurosurgery ◽  
2017 ◽  
Vol 80 (5) ◽  
pp. 754-758 ◽  
Author(s):  
Vinod Ravikumar ◽  
Allen L. Ho ◽  
Arjun V. Pendharkar ◽  
Eric S. Sussman ◽  
Kevin Kwong-hon Chow ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Cost Savings ◽  
Surgical Site Infections ◽  
Control Group ◽  
Infection Prophylaxis ◽  
Potential Cost Saving ◽  
Infection Rates ◽  
Surgical Prophylaxis ◽  
Potential Cost ◽  
Vancomycin Powder

Abstract BACKGROUND: Intrawound vancomycin powder has been studied extensively in spinal fusion surgeries and been found to reduce rates of surgical site infections (SSIs) significantly. Despite its success in spinal surgeries, topical vancomycin has not been extensively studied with respect to cranial neurosurgery. OBJECTIVE: To evaluate the efficacy of intrawound topical vancomycin for prevention of SSIs following open craniotomies. METHODS: We retrospectively analyzed a large series of 350 patients from 2011 to 2015 in a pre/postintervention study of use of topical vancomycin to reduce postoperative craniotomy infection rates. We had a preintervention control group of 225 patients and a postintervention group of 125 patients that received intrawound topical vancomycin. RESULTS: Our preintervention incidence of SSI was 2.2% and this was significantly reduced to 0% following introduction of topical vancomycin (P < .5). An ad hoc cost analysis suggested a cost savings of ${\$}$59 965 with the use of topical vancomycin for craniotomies. CONCLUSION: Our study found a significant reduction in SSI rates after introduction of topical vancomycin. Thus, this simple intervention should be considered in all open craniotomy patients as both infection prophylaxis and a potential cost saving intervention.

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.

Updating the Economic Impacts of the High/Scope Perry Preschool Program

2005 ◽  
Vol 27 (3) ◽  
pp. 245-261 ◽  
Author(s):  
Milagros Nores ◽  
Clive R. Belfield ◽  
W. Steven Barnett ◽  
Lawrence Schweinhart
Keyword(s):  
Treatment Group ◽  
Discount Rate ◽  
General Public ◽  
Net Present Value ◽  
Cost Benefit ◽  
Criminal Activity ◽  
Control Group ◽  
Preschool Program ◽  
Outcome Differences ◽  
Program Costs

This article derives an updated cost-benefit ratio for the High/Scope Perry Preschool Program, an intensive preschool intervention delivered during the 1960s to at-risk children in Ypsilanti, Michigan. Because children were randomly assigned to the program or a control group, differences in outcomes are probably attributable to program status. Data on outcome differences is now available on participants as they reached the age of 40; outcomes include educational attainment, earnings, criminal activity, and welfare receipt. These outcomes are rendered in money terms and compared to the costs of delivering the program to calculate the net present value of the program both for participants and for society. The data show strong advantages for the treatment group in terms of higher lifetime earnings and lower criminal activity. For the general public, gains in tax revenues, lower expenditures on criminal justice, lower victim costs, and lower welfare payments easily outweigh program costs. At a 3% discount rate the program repays $12.90 for every $1 invested from the perspective of the general public; with a 7% discount rate, the repayment per dollar is $5.67. Returns are even higher if the total benefits—both public and private—are counted. However, there are strong differences by gender: a large proportion of the gains from the program come from lower criminal activity rates by the treatment group, almost all of which is undertaken by the males in the sample. The implications of these findings for public policy on early childhood education are considered.

Cost–benefit analysis of telehealth in pre-hospital care

2016 ◽  
Vol 23 (8) ◽  
pp. 747-751 ◽  
Author(s):  
James R Langabeer ◽  
Tiffany Champagne-Langabeer ◽  
Diaa Alqusairi ◽  
Junghyun Kim ◽  
Adria Jackson ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Cost Benefit Analysis ◽  
Cost Savings ◽  
Cost Benefit ◽  
Hospital Environment ◽  
Control Group ◽  
Benefit Analysis ◽  
Hospital Emergency ◽  
Care Clinic

Objective There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative. Methods Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost–benefit analysis (CBA) comparing costs with potential savings associated with patients treated through a telehealth-enabled intervention. The intervention consisted of telehealth-based consultation between the 911 patient and an EMS physician, to evaluate and triage the necessity for patient transport to a hospital emergency department (ED). Patients with non-urgent, primary care-related conditions were then scheduled and transported by alternative means to an affiliated primary care clinic. We measured CBA as both total cost savings and cost per ED visit averted, in US Dollars ($USD). Results In total, 5570 patients were treated over the first full 12 months with a telehealth-enabled care model. We found a 6.7% absolute reduction in potentially medically unnecessary ED visits, and a 44-minute reduction in total ambulance back-in-service times. The average cost for a telehealth patient was $167, which was a statistically significantly $103 less than the control group ( p < .0001). The programme produced a $928,000 annual cost savings from the societal perspective, or $2468 cost savings per ED visit averted (benefit). Conclusion Patient care enabled by telehealth in a pre-hospital environment, is a more cost effective alternative compared to the traditional EMS ‘treat and transport to ED’ model.

Mesenchymal Stem Cell Derived Osteogenic Cells Is Superior to Bone Marrow Aspirate Impregnated Biomaterial Complex in Posterior Spinal Fusion

2007 ◽  
Vol 330-332 ◽  
pp. 1149-1152
Author(s):  
Chan Wai Chan ◽  
K.M. Lee ◽  
Ling Qin ◽  
K.H.K. Wong ◽  
H.Y. Yeung ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Spinal Fusion ◽  
Bone Marrow Aspirate ◽  
Fluorescent Microscopy ◽  
Posterior Spinal Fusion ◽  
Control Group ◽  
Fluorescent Signal ◽  
Osteogenic Cells ◽  
Green Fluorescent

The limited source of autograft has prompted extensive research on bone substitute and biological enhancement of the fusion mass in spinal fusion. Biomaterials impregnated with bone marrow aspirate has been applied to spinal fusion surgery. In this study, the effect of stem cell therapy in enhancing posterior spinal fusion was compared with the bone marrow aspirate method in a standard rabbit model. Bone marrow was aspirated from rabbit proximal femur (BMA group, n=6) and loaded on β-tricalcium phosphate ceramics (β-TCP) in excess. The composite was then implanted onto L5 and L6 transverse processes of the same animal in posterior spinal fusion operation with decortication on the same day. For stem cell therapy group, mesenchymal stem cells (MSCs) were isolated from bone marrow aspirate by adherence on plastic culture-ware. The MSCs were treated with osteogenic supplements (OS) during ex vivo cell expansion (MSC group, n=6). The osteogenic cells were seeded on β-TCP ceramics and cultured for one day. The cell-ceramics composite was implanted into the same rabbit as BMA group. The ceramics acted as control (n=6). Three fluorochromes, tetracycline, xyelonol orange and caclein were injected at week 2, 4 and 6 sequentially. The spinal segments were harvested at week 7 post-operation. The manual palpation of vertebral joint was assesses for solid fusion. The gap distance of inter-transverse process was measured by microCT and the bone mineral content (BMC) and volume of transverse processes by peripheral quantitative computed tomography. The specimens were undergone undecalcified histological analysis. The mineralization process was examined by fluorescent microscopy. By manual palpation, 50% of MSC group samples were found to have solid fusion in comparison with the incomplete fusion observed in the BMA and control group. The gap distance of inter-transverse processes in MSC group was the shortest. The volume of the transverse processes in MSC group was significantly greater than BMA and control group by 16% and 26% respectively. The BMC of transverse processes in MSC group was 40% greater than control (p<0.05) and 8% greater than BMA group. In fluorescent microscopy, both green fluorescent signal (labeled at week 6) and orange fluorescent signal (labeled at week 4) were observed in MSC group compare with the predominantly green fluorescent signal in the BMA group. In conclusion, the augmentation of MSC derived osteogenic cells is superior to bone marrow aspirate in rabbit posterior spinal fusion.

scholarly journals Prophylaxis of Surgical Site Infection in Cranial Surgery with Vancomycin Powder Application into Wound

2019 ◽  
Vol 23 (3) ◽  
pp. 205-210
Author(s):  
SAMI UR REHMAN ◽  
RIFFAT ULLAH KHAN ◽  
GHAYUR ABBAS ◽  
USAMA BIN ZUBAIR ◽  
KAMRAN KHAN ◽  
...  
Keyword(s):  
Treatment Group ◽  
Surgical Site Infection ◽  
Control Group ◽  
P Value ◽  
Site Infection ◽  
Significant Difference ◽  
Routine Prophylaxis ◽  
Vancomycin Powder ◽  
Vancomycin Group ◽  
Lost To Follow Up

Objective: To see the effect of application of Vancomycin powder directly into the subgaleal space in reducing the postoperative surgical site infections.Materials and Methods: All the patients who underwent consecutive elective craniotomies from April 2017 to May 2018 Dept of Neurosurgery, szabmu, PIMS, Islamabad. The control group received the standard routine prophylaxis according to the hospital protocols, whereas the treatment group, in addition to the standard prophylaxis, received Vancomycin powder in the surgical wound in addition to the standard routine prophylaxis. Results: 182 patients were enrolled in the study, 91 allocated to each the control and treatment group (Vancomycin). Six patients were lost to follow up. There were 90 patients in the control group and 86 patients in the treatment (Vancomycin) group. Both the groups were almost statistically similar. In the control group, 34.09% (n = 60) were male and 17.04% (n = 30) were female. In the treatment group, 29.54% (n = 52) were male and 19.31% (n = 34) were female. The overall rate of surgical site infection (SSI) was 3.97% (7 out of 176 cases). A statistically significant difference found in infection rate between the treatment group, 0% (0 out of 86 cases) and the control group, 7.77% (7 out of 90 cases) with the p value of 0.002. Conclusions: The use of topical Vancomycin powder in surgical wounds may significantly reduce the incidence of infection in patients undergoing elective craniotomies. It is a promising means of preventing devastating and harmful postoperative wound infections.

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

2018 ◽  
Vol 29 (2) ◽  
pp. 193-198 ◽  
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.

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.

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