Intrawound Vancomycin Decreases the Risk of Surgical Site Infection After Posterior Spine Surgery: A Multicenter Analysis.
Date
2018-01
Journal Title
Journal ISSN
Volume Title
Repository Usage Stats
views
downloads
Citation Stats
Abstract
Study design
Secondary analysis of data from a prospective multicenter observational study.Objective
The aim of this study was to evaluate the occurrence of surgical site infection (SSI) in patients with and without intrawound vancomycin application controlling for confounding factors associated with higher SSI after elective spine surgery.Summary of background data
SSI is a morbid and expensive complication associated with spine surgery. The application of intrawound vancomycin is rapidly emerging as a solution to reduce SSI following spine surgery. The impact of intrawound vancomycin has not been systematically studied in a well-designed multicenter study.Methods
Patients undergoing elective spine surgery over a period of 4 years at seven spine surgery centers across the United States were included in the study. Patients were dichotomized on the basis of whether intrawound vancomycin was applied. Outcomes were occurrence of SSI within postoperative 30 days and SSI that required return to the operating room (OR). Multivariable random-effect log-binomial regression analyses were conducted to determine the relative risk of having an SSI and an SSI with return to OR.Results
.: A total of 2056 patients were included in the analysis. Intrawound vancomycin was utilized in 47% (n = 966) of patients. The prevalence of SSI was higher in patients with no vancomycin use (5.1%) than those with use of intrawound vancomycin (2.2%). The risk of SSI was higher in patients in whom intrawound vancomycin was not used (relative risk (RR) -2.5, P < 0.001), increased number of levels exposed (RR -1.1, P = 0.01), and those admitted postoperatively to intensive care unit (ICU) (RR -2.1, P = 0.005). Patients in whom intrawound vancomycin was not used (RR -5.9, P < 0.001), increased number of levels were exposed (RR-1.1, P = 0.001), and postoperative ICU admission (RR -3.3, P < 0.001) were significant risk factors for SSI requiring a return to the OR.Conclusion
The intrawound application of vancomycin after posterior approach spine surgery was associated with a reduced risk of SSI and return to OR associated with SSI.Level of evidence
2.Type
Department
Description
Provenance
Citation
Permalink
Published Version (Please cite this version)
Publication Info
Devin, Clinton J, Silky Chotai, Matthew J McGirt, Alexander R Vaccaro, Jim A Youssef, Douglas G Orndorff, Paul M Arnold, Anthony K Frempong-Boadu, et al. (2018). Intrawound Vancomycin Decreases the Risk of Surgical Site Infection After Posterior Spine Surgery: A Multicenter Analysis. Spine, 43(1). pp. 65–71. 10.1097/brs.0000000000001371 Retrieved from https://hdl.handle.net/10161/31334.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
Collections
Scholars@Duke
Douglas George Orndorff
I have over 15 years of experience in private practice spine care, primarily in a small rural town serving a large geographical area. Being one of the few spine surgeons for such a large area allowed me to become adept at recognizing and treating virtually all adult spinal conditions. My goal is to maximize non-surgical options first, with the goal of getting my patients back to the activities they love as fully as possible. I have partnered with top spine companies in the field to develop multiple cutting edge products that are now being used in spine surgeries worldwide. I am particularly interested in motion preservation surgery, improving fusion outcomes, and spine navigation. My treatment philosophy is to engage patients in their own spine health care, working together to tailor the best possible course of action for their individual needs and lifestyle.
Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.