Intrawound Vancomycin Powder for Spine Tumor Surgery

Abstract

Study Design Retrospective evaluation of prospectively collected data. Objective To evaluate infection rates following intrawound vancomycin powder application during spine tumor surgery. Methods Patients ≥18 years old undergoing spine tumor surgery and receiving intrawound vancomycin powder at a single center between January 2008 and January 2015 were enrolled. Patient demographics (age, sex, body mass index [BMI]), tumor type (metastatic, primary) and location, surgical data (estimated blood loss [EBL], levels fused, type of decompression, length of surgery and hospitalization, discharge status from hospital), radiation therapy use, and infection rates (surgery to a minimum of 30 days postoperative) were evaluated. Results Forty patients (46 procedures) undergoing spine tumor surgery and intrawound vancomycin powder application were identified. Five were excluded because of death less than 30 days postoperatively, and 35 patients (41 procedures) were enrolled: 11 women and 24 men with an average age of 61.4 years (range 19 to 92) and average BMI of 27.3 (range 17.4 to 36.8). Three cases were primary spine tumors. Five were hematologic malignancies, and 27 were metastatic cancers. Twenty-one tumors were in the thoracic spine, 12 in the lumbar spine, and 8 in the cervical spine. Average EBL was 899 mL (range 25 to 3,500), average length of surgery was 241 minutes (range 78 to 495), and average hospital stay was 15.1 days (range 3 to 49). Two culture-proven infections (Staphylococcus aureus, Enterobacter cloacae) were noted in 41 procedures (4.9%). Ten patients (28.6%) had preoperative radiation only; 14 (40%) had postoperative radiation only, 5 (14.3%) had both preoperative and postoperative radiation, and 6 (17.1%) had no radiation. There were no associations between radiation treatment and postsurgical infections (p = 0.19). Conclusion In this first study evaluating intrawound vancomycin powder for spine tumor surgery, we report an infection rate of 4.9%. We found no correlations between radiation treatment and postsurgical infections.

Effect of Intra‐wound Vancomycin for Spinal Surgery: A Systematic Review and Meta‐analysis

“…Ghobrial et al demonstrated that the incidence of gram‐negative or polymicrobial spinal infections increased after using prophylactic intraoperative vancomycin during various spinal surgeries, with negative culture outcomes for wound infections derived from degenerative disease but positive cultures for those following spinal trauma surgery. In addition, minimal effectiveness of intra‐wound vancomycin powder use during spinal tumor surgery was revealed by Liu and Okafor. Okafor also revealed an infection rate of 4.9% after evaluating the use of intra‐site vancomycin powder during spinal tumor surgeries, and Liu revealed an insufficient benefit of it for patients undergoing spinal tumor surgeries (8.0% vs .…”

Intraoperative Site Vancomycin Powder Application in Infected Diabetic Heel Ulcers With Calcaneal Osteomyelitis

“…The effectiveness of intraoperative site vancomycin powder administration for the prevention of postoperative infection in orthopedics has been demonstrated in multiple subspecialties. 12,17,18,19,23 The low cost of vancomycin powder compared to the extraordinary cost of orthopedic infections means that it has a favorable cost-benefit profile even with a high number needed to treat. 12 In the current health care compensation environment, an intervention such as vancomycin powder for orthopedic infection prevention or treatment is highly attractive.…”

“…7,10,11,21,22 Most literature on the efficacy of prophylactic vancomycin powder has focused on its ability to prevent infection after spine surgery, which has a higher risk of operative site infection compared with other orthopedic surgeries. 14,17,18 One study of diabetic patients undergoing foot and ankle surgery without an active infection found that intraoperative site vancomycin application decreased the risk of operative site infection. 23 At the 2018 International Consensus Meeting on Musculoskeletal Infection (Philadelphia, PA), a group of experts voiced their concern for generalizing this practice for total ankle arthroplasty or other foot and ankle procedures as there is insufficient evidence to support benefit vs risk associated with intraoperative site application of vancomycin powder.…”

What’s New in Musculoskeletal Infection: Update Across Orthopaedic Subspecialties

“…The authors of a Level-IV study reported an association between decreased infection rate and the use of vancomycin powder in degenerative spine surgery (a rate of 1.3% without and 0.4% with the use of vancomycin) 104 . Another observational study in 1 center reported SSI in 2 (4.9%) of 41 spine tumor procedures when vancomycin was used, but the rate without vancomycin use was not reported 105 .…”

“…There were 3 studies that reported on the delivery of vancomycin powder to surgical wounds [103][104][105] . Bone healing was reported to be unaffected 103 .…”