• HeyHwee Weng DennisHWDDepartment of Orthopaedic Surgery, National University Hospital, Singapore, Singapore., Desmond Wei Thiam, KohZhi Seng DarrenZSDDepartment of Orthopaedic Surgery, National University Hospital, Singapore, Singapore., Joseph Shantakumar Thambiah, Naresh Kumar, Leok-Lim Lau, Ka-Po Gabriel Liu, and Hee-Kit Wong.
• Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.
• Spine. 2017 Feb 15; 42 (4): 267-274.

Study DesignThis is a retrospective cohort comparative study of all patients who underwent instrumented spine surgery at a single institution.ObjectiveTo compare the rate of surgical site infection (SSI) between the treatment (vancomycin) and the control group (no vancomycin) in patients undergoing instrumented spine surgery.Summary Of Background DataSSI after spine surgery is a dreaded complication associated with increased morbidity and mortality. Prophylactic intraoperative local vancomycin powder to the wound has been recently adopted as a strategy to reduce SSI but results have been variable.MethodsIn the present study, there were 117 (30%) patients in the treatment group and 272 (70%) patients in the comparison cohort. All patients received identical standard operative and postoperative care procedures based on protocolized department guidelines. The present study compared the rate of SSI with and without the use of prophylactic intraoperative local vancomycin powder in patients undergoing various instrumented spine surgery, adjusted for confounders.ResultsThe overall rate of SSI was 4.7% with a decrease in infection rate found in the treatment group (0.9% vs. 6.3%). This was statistically significant (P = 0.049) with an odds ratio of 0.13 (95% confidence interval 0.02-0.99). The treatment group had a significantly shorter onset of infection (5 vs. 16.7 days; P < 0.001) and shorter duration of infection (8.5 vs. 26.8 days; P < 0.001). The most common causative organism was Pseudomonas aeruginosa (35.2%). Patient diagnosis, surgical approach, and intraoperative blood loss were significant risk factors for SSI after multivariable analysis.ConclusionProphylactic Intraoperative local vancomycin powder reduces the risk and morbidity of SSI in patients undergoing instrumented spine surgery. P. aeruginosa infection is common in the treatment arm. Future prospective randomized controlled trials in larger populations involving other spine surgeries with a long-term follow-up duration are recommended.Level Of Evidence3.

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