• Abuduwufuer Tailaiti, Jun Shang, Shuo Shan, and Aikeremujiang Muheremu.
• Department of Orthopedic Surgery, Urumqi Friendship Hospital, Xinjiang 86830049, China.
• Ther Clin Risk Manag. 2018 Jan 1; 14: 2149-2159.

BackgroundDespite great advances in aseptic surgical techniques, surgical site infection (SSI) is still one of the main complications after spine surgery. SSI can bring tremendous physical, psychological, and economic challenges to patients. Intrawound vancomycin application is a much disputed method for the prevention of SSI after spine surgery.ObjectiveThe aim of this study is to review the current literature for studies on the intra-wound application of vancomycin powder and to analyze its effectiveness in the prevention of postoperative SSI.MethodsPubMed, Medline, Elsevier, and CNKI were searched for the key words "vancomycin", "local/intraoperative/topical/intra-wound", "spine/spinal/lumbar/cervical/thoracolumbar surgery", "infection", and "SSI" in published studies on the effectiveness of intrawound vancomycin application to prevent postoperative SSI. RevMan 5.3 was used to compare the data extracted from the studies included.ResultsA total of 27 studies involving 17,321 patients were included in the final analysis. Among those patients, 7,423 patients were treated with vancomycin to prevent SSI, with 9,898 in control groups. SSI incidence after surgery in experimental groups was 0.39 times as high as control groups, and this difference was statistically significant (P<0.01). Among patients who underwent internal fixation, vancomycin application significantly reduced the incidence of postoperative SSI (OR 0.31 95% CI 0.19-0.50; P<0.01). Meanwhile, vancomycin did not affect SSI incidence in patients who did not receive internal fixation (P=0.17) or received deformity correction (P=0.25).ConclusionSSI incidence after spinal surgery can be significantly reduced by intrawound application of vancomycin in most circumstances. This method can be applied in various spinal procedures involving instrumentation to prevent postoperative SSI.

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