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Fewer infections seen in cervical spine surgery with new vancomycin protocol
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SAN DIEGO — No acute infections occurred in 195 patients who had vancomycin powder placed in their cervical spine surgical wounds in a retrospective controlled study presented here at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.
Joshua Pahys, MD, of Philadelphia, presented results of the 1,001-patient study. Pahys and colleagues evaluated the effectiveness of three infection control practices used in patients treated by senior investigator K. Daniel Riew, MD, between 1995 and 2010.
The investigators compared results of the following infection control practices used during different time periods:
- using intravenous antibiotics peri-operatively in a control group of 483 patients;
- pre-prepping patients’ skin and plastic surgical draping with alcohol foam, and using suprafascial and subfascial drains in 323 patients; and
- augmenting the alcohol foam/drain practice by adding 500 mg vancomycin powder to the wound prior to closure.
 Joshua Pahys |
“Comparing the three groups collectively, there was a 1.86% infection rate in the control group. This was lowered to one infection in 323 consecutive patients in the alcohol foam and drain group for a rate of 0.3%, and lowered even further to 0% infections in 195 consecutive patients in the vancomycin group — both of which were significant reductions compared to the control,” Pahys said.
In discussing other findings from the study, he said patients with infections had operative times that were more than 60 minutes longer than for those without infections.
A limitation of the study was that the three groups were fairly dissimilar. For example, the latter groups of patients were significantly older than controls.
“Further, the alcohol foam and drain group had a statistically significant higher rate of revision procedures, procedures involving greater than or equal to four levels and procedures where BMP [bone morphogenetic protein] would be involved,” Pahys said. He noted that more complicated procedures, increased BMP usage and more revisions were also associated with the vancomycin group.
Reference:
- Pahys J, Pahys JR, Cho S K-W, et al. Methods to decrease post-operative infections following posterior cervical spine surgery. Paper #30. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19, 2011. San Diego.
Disclosure: Pahys has no relevant financial disclosures.
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