Secondary Logo

Journal Logo

Prophylactic Operative Site Powdered Vancomycin and Postoperative Deep Spinal Wound Infection: 1,512 Consecutive Surgical Cases during a Six‐Year Period: PAPER #37

Molinari, William J. MD; Khera, Oner MD; Molinari, Robert W. MD

Author Information
Spine Journal Meeting Abstracts: 2011 - Volume - Issue - p 73–74
  • Free

Summary: During a 6‐year period 1512 consecutive adult spinal surgical cases were performed by a single surgeon in which 1 gram of powdered vancomycin was placed in the wound prior to closure. The overall rate of deep wound infection was .86% (13/1512). The rate of deep wound infection was 0.90% (6/663) for instrumented spinal surgeries, and 0.82% (7/849) for uninstrumented surgeries. Deep infection occurred in only 0.93% (3/324) of multilevel instrumented posterior spinal fusion procedures The use of intraoperative powered vancomycin appears to be associated with a low rate deep spinal wound infection in this case series. Rates of deep infection for instrumented fusion surgeries in this series appear to be among the lowest reported in the existing literature. Further investigation of this prophylactic measure is warranted.

Introduction: The use of intraoperative powdered vancomycin as a prophylactic measure in an attempt to reduce the incidence of postoperative deep spinal wound infection has not been sufficiently evaluated in the existing literature.

Methods: During the period from 2005‐2010, 1512 consecutive adult spinal surgery cases were performed by the same fellowship‐trained spinal surgeon (RWM) at a level one trauma center. One gram of powdered vancomycin was placed in all surgical sites prior to wound closure. 849 cases were uninstrumented, 443 cases were instrumented posterior thoracic or lumbar, 27 instrumented anterior thoracic or lumbar, 146 instrumented anterior cervical,47 instrumented posterior cervical. A retrospective operative data base and medical record review was performed to evaluate for evidence of postoperative wound infection.

Results: 13 of the 1512 patients (0.86%) were identified as having evidence of postoperative deep wound infection. All 13 patients had reoperation for wound irrigation, debridement, and reclosure. Staph aureus and MRSA were the most commonly identified organisms (10/13 cases). The rate of deep wound infection was 0.90% (6/663) for instrumented spinal surgeries, and 0.82% (7/849) for uninstrumented surgeries. Deep infection occurred in only 0.93% (3/324) of multilevel instrumented posterior spinal fusions, 0.73% (1/73) of open PLIF procedures, and 0.81% (1/81) of single‐level instrumented posterior fusions. Deep infection was not observed in any patient who had uninstrumented spinal fusion (0/162). Increased rates of complications related to powered vancomycin use were not identified in this series.

Conclusion: Powdered intraoperative vancomycin placed in the wound prior to closure appears to associated with a low rate deep spinal wound infection in both instrumented and uninstrumented cases. Rates of deep infection for instrumented fusion surgeries appear to be among the lowest reported in the existing literature. Further investigation of this prophylactic measure using the case‐controlled methodology with larger surgical subpopulations is warranted.

Significance: Rates of deep infection for instrumented spinal fusion surgeries in this series appear to be among the lowest reported in the existing literature.

© 2011 Lippincott Williams & Wilkins, Inc.