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Application of Vancomycin Powder to Reduce Surgical Infection and Deep Surgical Infection in Spinal Surgery

A Meta-analysis

He, Xiaoqi, MD*,†; Sun, Tianwei, MD; Wang, Jizhou, MD; Li, Guang, MD; Fei, Qiaoman, MD*

doi: 10.1097/BSD.0000000000000778

Study Design: This was a meta-analysis study.

Objective: Our meta-analysis study aimed to evaluate the efficacy of vancomycin powder to reduce the surgical site infection (SSI) in spinal surgery.

Summary of Background Data: The SSI is a potential and devastating complication after spinal surgery. Local application of vancomycin powder is an attractive adjunctive therapy to reduce SSI in spinal surgery.

Methods: Studies were identified from PubMed, The Cochrane Library, AMED, Web of Science, Scopus, Ovid, EMBASE, and Ebsco Medline. The fixed-effects model was used to compute the merge of relative risk and 95% confidence interval (CI). Heterogeneity tests were checked by I2 statistics. Subgroup analysis was performed to determine whether vancomycin powder was beneficial, that could reduce the SSI in spinal surgery, or not. Publication bias was explored by funnel plot.

Results: We included 21 studies for final analysis. In our analysis, application of vancomycin powder was associated with a significantly reduced risk of SSI and deep SSI. Pooled relative risks showed significant changes: SSI, 0.36 (95% CI: 0.27–0.47, P=0.000), SSI in the instrumented group, 0.35 (95% CI: 0.25–0.49, P=0.000), SSI in the noninstrumented group, 0.39 (95% CI: 0.24–0.65, P=0.000), deep SSI, 0.28 (95% CI: 0.18–0.44, P=0.000), and the incidence pseudoarthrosis, 0.88 (95% CI: 0.35–2.21, P=0.784). In the subgroup analysis, vancomycin powder showed beneficial effects to SSI in the instrumented group. Pooled the heterogeneity: SSI (P=0.124, I2=30.0%), SSI in the instrumented group (P=0.366, I2=8.2%), SSI in the noninstrumented group (P=0.039, I2=60.5%), deep SSI (P=0.107, I2=33.5%).

Conclusions: The application of vancomycin powder could decrease the SSI and deep SSI in spinal surgery. In the subgroup, vancomycin powder is beneficial to the SSI in the instrumented group. The available evidence is too limited to make the conclusion that the use of vancomycin powder causes pseudoarthrosis in spinal surgery, its extrapolation should be carefully executed.

*Graduate School of Tianjin Medical University

Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, People's Republic of China

The authors declare no conflict of interest.

Reprints: Tianwei Sun, MD, Department of Spinal Surgery, Tianjin Union Medical Center, 190 Jieyuan Rd, Hongqiao District, Tianjin 300121, People’s Republic of China (e-mail:

Received January 8, 2018

Accepted November 26, 2018

© 2019 by Lippincott Williams & Wilkins, Inc.