Summary: 920 adult spinal deformity procedures were analyzed after receiving preop and postop IV antibiotics alone (IV‐ABX) or preop and postop IV antibiotics and intrawound Vancomycin powder (IW‐vanco + ABX). The IW‐vanco+ABX group had a lower acute infection rate versus IV‐ABX alone (0.7% vs. 5%; p<0.0001) Intrawound vanco powder is effective in lowering acute deep wound postop infection rates.
Introduction: Postop spinal infection can be a devastating complication, especially for pts with instrumentation. The novel use of intrawound vanco powder has been reported in spinal surgery patients, but not in the spinal deformity population. We hypothesize that intraop administration of intrawound vanco powder plus IV Antibiotics will effectively lower the rate of acute postoperative infections when compared to IV antibiotics alone.
Methods: A single center study of 920 procedures was undertaken. The control group, IV‐ABX, (N=334) had preop/postop IV antibiotics only & underwent spinal deformity surgery between 2002‐2005. The study group, IW‐vanco+ABX, (N=586) received preop/postop IV antibiotics plus intraop intrawound vanco powder (1‐2gm) and underwent surgery between 2007‐2010. 2005‐2007 was a transition period with some pts receiving the vanco powder and some not; therefore, we excluded this time period to reduce inaccuracy. 2 surgeons operated on both groups; prepping, draping, and staff were unchanged between the control and the study group. The vanco powder (500‐1000gm) was applied immediately before closure onto the spine and paraspinal musculature. Additional vanco powder (500‐1000gm) was placed directly onto the closed fascia. All pts had Hemovac drains deep and superficial with IV antibiotics continued until all drains removed. Infection was defined as deep wound process requiring operative I&D within 90 days of index procedure. Stats: Chi2.
Results: The deep wound infection rate for IW‐vanco+ABX (4/586) = 0.7% was significantly less than the IV‐ABX rate of (16/334) = 5% [p<0.0001]. Evaluation of infected procedures showed: revision surgeries: 75% (IWvanco+ABX) vs 50% (IV‐Abx); smoking: 25% (IW‐vanco+ABX) vs 38% (IV‐Abx); BMI >0 kg/m2 25% (IW‐vanco+ABX) vs 50% (IV‐Abx). Further study group characterization included in Figure 1. The small number of infections prevents statistical analysis of differences among infected patients. There were no complications associated with the use of intrawound vanco.
Conclusion: Intrawound Vancomycin powder along with IV‐ABX effectively lowers the deep postop wound infection rate in adult spinal deformity pts vs IV‐ABX alone. This method is both a safe and inexpensive in lowering deep wound infection rates.