Osa Emohare1, Charles G Ledonio2, Brian W Hill3, Rick A Davis4, David W Polly2, Matthew M Kang5. 1. Department of Neurosurgery, Mail Stop 11503G, Regions Hospital, 640 Jackson Street, Saint Paul, MN, 55101. Electronic address: oemohare@umn.edu. 2. Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55454. 3. Department of Orthopaedic Surgery, Saint Louis University, 3635 Vista at Grand Blvd. St. Louis, Missouri 63104. 4. Department of Orthopaedic Surgery, Mail Stop 11503L, Regions Hospital, 640 Jackson Street, Saint Paul, MN 55101. 5. Department of Neurosurgery, Mail Stop 11503G, Regions Hospital, 640 Jackson Street, Saint Paul, MN, 55101.
Abstract
BACKGROUND CONTEXT: Recent studies have shown that prophylactic use of intrawound vancomycin in posterior instrumented spine surgery substantially decreases the incidence of wound infections requiring repeat surgery. Significant cost savings are thought to be associated with the use of vancomycin in this setting. PURPOSE: To elucidate cost savings associated with the use of intrawound vancomycin in posterior spinal surgeries using a budget-impact model. STUDY DESIGN: Retrospective cohort study. PATIENT SAMPLE: Data from a cohort of 303 patients who underwent spinal surgery (instrumented and noninstrumented) over 2 years were analyzed; 96 of these patients received prophylactic intrawound vancomycin powder in addition to normal intravenous (IV) antibiotic prophylaxis, and 207 received just routine IV antibiotic prophylaxis. Patients requiring repeat surgical procedures for infection were identified, and the costs of these additional procedures were elucidated. OUTCOME MEASURE: Cost associated with the additional procedure to remediate infection in the absence of vancomycin prophylaxis. METHODS: We retrospectively reviewed the cost of return procedures for treatment of surgical site infection (SSI). The total reimbursement received by the health care facility was used to model the costs associated with repeat surgery, and this cost was compared with the cost of a single local application of vancomycin costing about $12. RESULTS: Of the 96 patients in the treatment group, the return-to-surgery rate for SSI was 0. In the group without vancomycin, seven patients required a total of 14 procedures. The mean cost per episode of surgery, based on the reimbursement, the health care facility received was $40,992 (range, $14,459-$114,763). A total of $573,897 was spent on 3% of the 207-patient cohort that did not receive intrawound vancomycin, whereas a total of $1,152 ($12×96 patients) was spent on the cohort treated with vancomycin. CONCLUSIONS: This study shows a reduction in SSIs requiring a return-to-surgery-with large cost savings-with use of intrawound vancomycin powder. In our study population, the cost savings totaled more than half a million dollars.
BACKGROUND CONTEXT: Recent studies have shown that prophylactic use of intrawound vancomycin in posterior instrumented spine surgery substantially decreases the incidence of wound infections requiring repeat surgery. Significant cost savings are thought to be associated with the use of vancomycin in this setting. PURPOSE: To elucidate cost savings associated with the use of intrawound vancomycin in posterior spinal surgeries using a budget-impact model. STUDY DESIGN: Retrospective cohort study. PATIENT SAMPLE: Data from a cohort of 303 patients who underwent spinal surgery (instrumented and noninstrumented) over 2 years were analyzed; 96 of these patients received prophylactic intrawound vancomycin powder in addition to normal intravenous (IV) antibiotic prophylaxis, and 207 received just routine IV antibiotic prophylaxis. Patients requiring repeat surgical procedures for infection were identified, and the costs of these additional procedures were elucidated. OUTCOME MEASURE: Cost associated with the additional procedure to remediate infection in the absence of vancomycin prophylaxis. METHODS: We retrospectively reviewed the cost of return procedures for treatment of surgical site infection (SSI). The total reimbursement received by the health care facility was used to model the costs associated with repeat surgery, and this cost was compared with the cost of a single local application of vancomycin costing about $12. RESULTS: Of the 96 patients in the treatment group, the return-to-surgery rate for SSI was 0. In the group without vancomycin, seven patients required a total of 14 procedures. The mean cost per episode of surgery, based on the reimbursement, the health care facility received was $40,992 (range, $14,459-$114,763). A total of $573,897 was spent on 3% of the 207-patient cohort that did not receive intrawound vancomycin, whereas a total of $1,152 ($12×96 patients) was spent on the cohort treated with vancomycin. CONCLUSIONS: This study shows a reduction in SSIs requiring a return-to-surgery-with large cost savings-with use of intrawound vancomycin powder. In our study population, the cost savings totaled more than half a million dollars.
Authors: Craig Winkler; Joel Dennison; Adam Wooldridge; Eneko Larumbe; Cyrus Caroom; Mark Jenkins; George Brindley Journal: J Clin Orthop Trauma Date: 2017-08-24
Authors: James X Liu; Dalibel Bravo; John Buza; Thorsten Kirsch; Oran Kennedy; Andrew Rokito; Joseph D Zuckerman; Mandeep S Virk Journal: J Orthop Date: 2018-01-30
Authors: Gabriel J Pavey; Peter M Formby; Benjamin W Hoyt; Scott C Wagner; Jonathan A Forsberg; Benjamin K Potter Journal: Clin Orthop Relat Res Date: 2019-04 Impact factor: 4.176
Authors: Dane K Wukich; Jeffrey W Dikis; Spencer J Monaco; Kristin Strannigan; Natalie C Suder; Bedda L Rosario Journal: Foot Ankle Int Date: 2015-05-12 Impact factor: 2.827
Authors: Lauren J Delaney; Cemile Basgul; Daniel W MacDonald; Keith Fitzgerald; Noreen J Hickok; Steven M Kurtz; Flemming Forsberg Journal: Ultrasound Med Biol Date: 2019-11-13 Impact factor: 2.998
Authors: Howard Y Park; Vishal Hegde; Stephen D Zoller; William Sheppard; Christopher Hamad; Ryan A Smith; Marina M Sprague; Joshua D Proal; John Hoang; Amanda Loftin; Gideon Blumstein; Zachary Burke; Nicolas Cevallos; Anthony A Scaduto; Nicholas M Bernthal Journal: Spine J Date: 2019-12-19 Impact factor: 4.166