General Session: Tumor, Trauma, Infection - Hall F

Presented by: R. Schär

Author(s):

S. Haimoto(1), R. Schär(1), Y. Nishimura(2), M. Hara(3), T. Wakabayashi(2), H. Ginsberg(1)

(1) St. Michael's Hospital, University of Toronto, Neurosurgery, Toronto, ON, Canada
(2) Nagoya University Graduate School of Medicine, Neurosurgery, Nagoya, Japan
(3) Inazawa Municipal Hospital, Neurosurgery, Inazawa, Japan

Abstract

Objective: Recent studies have demonstrated the efficacy of subfascial intrawound application of vancomycin powder in spine surgery to reduce 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.

Methods: We conducted a single-center retrospective case-control study of adult patients undergoing open instrumented posterior fusion of the cervical, thoracic, or lumbar spine by a single surgeon from January 2010 through December 2016. In March 2013 routine application of 1 gram of suprafascial vancomycin powder was started for all cases in addition to standard systemic antibiotic prophylaxis. Baseline demographics, operative data as well as the SSI rates were compared between the study groups. The incidence of vancomycin powder-related adverse effects was analyzed.

Results: A total of 515 patients (268 in the control group and 247 in the treatment group) were included in the study. The mean age was significantly higher in the treatment group than in the control 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 control group vs. 0% in the treatment group, p < 0.001). No vancomycin powder-related adverse effects were identified in the treatment group.

Conclusions: Routine 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 may be the preferred method over previously reported subfascial distribution due to minimizing the risk of local adverse drug reactions.