Sumeet Garg1, Nikki Bloch2, Morgan Potter2, Hannah Quick2, Claire Palmer3, Nicole Michael2, Courtney O'Donnell4, Mark Erickson4. 1. Orthopaedics Institute, Children's Hospital Colorado, 13123 East 16th Ave, Aurora, CO 80045, USA. Electronic address: sumeet.garg@childrenscolorado.org. 2. Musculoskeletal Research Center, Children's Hospital Colorado, 13123 East 16th Ave, Aurora, CO 80045, USA. 3. Department of Pediatrics, School of Medicine, University of Colorado Denver, AMC Building 500, Mail Stop C243, 13001 E. 17th Place, Aurora, CO 80045, USA. 4. Orthopaedics Institute, Children's Hospital Colorado, 13123 East 16th Ave, Aurora, CO 80045, USA.
Abstract
STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Evaluate the effectiveness of topical vancomycin in reducing surgical site infection (SSI) in pediatric patients undergoing posterior spinal fusion (PSF). SUMMARY OF BACKGROUND DATA: There has been increased interest in use of topical vancomycin to reduce SSI in spine surgery with mixed results reported in the literature. In Summer 2012, our institution implemented the use of topical vancomycin in definitive primary and revision PSF as part of our infection control protocol. METHODS: After IRB approval, a consecutive series of 527 patients (538 procedures) undergoing PSF January 2010-December 2014 were retrospectively reviewed to identify the occurrence of SSI. Based on published results from a similar study, an a priori power analysis determined 190 patients were needed per group to achieve 0.90 power. In 228 procedures, topical vancomycin was used (Vanco) and in 310 procedures it was not (No Vanco). Exclusion criteria were <90 days follow-up, >18 years at time of surgery, and combined anterior and posterior fusion. Two-sample t tests, Wilcoxon rank-sum tests, and Fisher exact tests were used to compare the cohorts. RESULTS: Groups were similar in age, sex, implant density, fusion length, risk categorization, and surgical time (p > .05). No Vanco had significantly higher blood loss and incidence and amount of intraoperative allogenic transfusion (p < .001). Incidence of SSI was 3% (7/228) in Vanco and 2% (6/310) in No Vanco (p = .4099). Six of the 7 SSIs occurred in high-risk patients in Vanco and 5 of 6 occurred in high-risk patients in No Vanco (p = 1). Reoperation within 90 days was 6% (13/228) in Vanco and 4% (11/310) in No Vanco (p = .2912). Occurrence of other complications was similar between Vanco, 3% (7/228), and No Vanco, 2% (5/310). CONCLUSION: Use of topical vancomycin did not reduce incidence of SSI for pediatric patients undergoing PSF at our institution. LEVEL OF EVIDENCE: Level III.
STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Evaluate the effectiveness of topical vancomycin in reducing surgical site infection (SSI) in pediatric patients undergoing posterior spinal fusion (PSF). SUMMARY OF BACKGROUND DATA: There has been increased interest in use of topical vancomycin to reduce SSI in spine surgery with mixed results reported in the literature. In Summer 2012, our institution implemented the use of topical vancomycin in definitive primary and revision PSF as part of our infection control protocol. METHODS: After IRB approval, a consecutive series of 527 patients (538 procedures) undergoing PSF January 2010-December 2014 were retrospectively reviewed to identify the occurrence of SSI. Based on published results from a similar study, an a priori power analysis determined 190 patients were needed per group to achieve 0.90 power. In 228 procedures, topical vancomycin was used (Vanco) and in 310 procedures it was not (No Vanco). Exclusion criteria were <90 days follow-up, >18 years at time of surgery, and combined anterior and posterior fusion. Two-sample t tests, Wilcoxon rank-sum tests, and Fisher exact tests were used to compare the cohorts. RESULTS: Groups were similar in age, sex, implant density, fusion length, risk categorization, and surgical time (p > .05). No Vanco had significantly higher blood loss and incidence and amount of intraoperative allogenic transfusion (p < .001). Incidence of SSI was 3% (7/228) in Vanco and 2% (6/310) in No Vanco (p = .4099). Six of the 7 SSIs occurred in high-risk patients in Vanco and 5 of 6 occurred in high-risk patients in No Vanco (p = 1). Reoperation within 90 days was 6% (13/228) in Vanco and 4% (11/310) in No Vanco (p = .2912). Occurrence of other complications was similar between Vanco, 3% (7/228), and No Vanco, 2% (5/310). CONCLUSION: Use of topical vancomycin did not reduce incidence of SSI for pediatric patients undergoing PSF at our institution. LEVEL OF EVIDENCE: Level III.
Authors: Rawan T Tafish; Ahmed F Alkhaldi; Anouar Bourghli; Turki A Althunian Journal: Antimicrob Resist Infect Control Date: 2021-09-26 Impact factor: 4.887