Prophylaxis of surgical site infection in adult spine surgery: A systematic review

Yao, Reina; Tan, Terence; Tee, Jin; Street, John

doi:10.1016/j.jocn.2018.03.023

Cited by 40 publications

(35 citation statements)

References 144 publications

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“…Ineffective skin sealing following spine surgeries can lead to significant complications including surgical site infections and wound dehiscence . In order to investigate the efficacy of skin sealing in an animal model with incisions similar to those in spine surgeries, full‐thickness dorsal skin incisions, 1 cm in length, were made in BALB/c mice and closed with PGA sutures ( Figure A), silk sutures (Figure B), LATIS alone (Figure C), and LATIS irradiated with 2.4 W cm −2 laser (Figure D).…”

Section: Resultsmentioning

confidence: 99%

Light‐Activated Tissue‐Integrating Sutures as Surgical Nanodevices

Ghosh

Urie

Chang

et al. 2019

Adv Healthcare Materials

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Sutures are typically the primary means of soft tissue repair in surgery and trauma. Despite their widespread use, sutures do not result in immediate sealing of approximated tissues, which can result in bacterial infection and leakage. Nonabsorbable sutures and staples can be traumatic to tissue, and the trauma can be exacerbated by their subsequent removal. Use of cyanoacrylate glues is limited because of their brittleness and toxicity. In this work, laser‐activated tissue‐integrating sutures (LATIS) are described as novel nanodevices for soft tissue approximation and repair. Incorporation of gold nanorods within fibers generated from collagen result in LATIS fibers which demonstrate robust photothermal responses following irradiation with near infrared laser light. Compared to conventional sutures, LATIS fibers result in greater biomechanical recovery of incised skin in a mouse model of skin closure after spine surgeries. Histopathology analyses show improved repair of the epidermal gap in skin, which indicate faster tissue recovery using LATIS. The studies indicate that LATIS‐facilitated approximation of skin in live mice synergizes the benefits of conventional suturing and laser‐activated tissue integration, resulting in new approaches for faster sealing, tissue repair, and healing.

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Section: Resultsmentioning

confidence: 99%

Light‐Activated Tissue‐Integrating Sutures as Surgical Nanodevices

Ghosh

Urie

Chang

et al. 2019

Adv Healthcare Materials

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“…The intra-wound application of vancomycin powder has been utilized for infection prophylaxis across a variety of surgical specialties, including multiple subspecialties of orthopedic surgery. 10,11 The effect has been a demonstrable decrease in infection without any appreciable complications. 12,13 With regard to spine surgery, Sweet et al demonstrated that vancomycin powder reduced the deep infection rate after thoracic and lumbar instrumented spinal fusions from 2.6% to 0.2% compared to traditional intravenous antibiotics, with no adverse clinical or wound complications.…”

Section: Discussionmentioning

confidence: 99%

“…9 Rising prevalence of methicillin resistance and recognition of S aureus colonization as a modifiable risk factor for wound infection has resulted in a growing adoption of prophylactic antibiotic usage in spine surgery to prevent infection with S aureus and other gram-positive microbes. 10,11 In particular, vancomycin powder has been added as a local application in wound beds for cardiac, vascular, spine, and a variety of other orthopedic procedures. 10,11 The effect has been a demonstrable decrease in infection without any appreciable complications.…”

Section: Introductionmentioning

confidence: 99%

“…10,11 In particular, vancomycin powder has been added as a local application in wound beds for cardiac, vascular, spine, and a variety of other orthopedic procedures. 10,11 The effect has been a demonstrable decrease in infection without any appreciable complications. 12,13 Sweet et al found that the addition of vancomycin powder to traditional intravenous antibiotics reduced the deep infection rate after thoracic and lumbar instrumented spinal fusions from 2.6% to 0.2%, with no adverse clinical or wound complications.…”

Section: Introductionmentioning

confidence: 99%

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The Cost-Effectiveness of Vancomycin Powder in Lumbar Laminectomy

Kerbel

Kirchner

Sunkerneni

et al. 2019

Global Spine Journal

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Study Design: Break-even cost analysis. Objective: The goal of this study is to examine the cost-effectiveness of vancomycin powder for preventing infection following lumbar laminectomy. Methods: The product cost of vancomycin powder was obtained from our institution’s purchasing records. Infection rates and revision costs for lumbar laminectomy and lumbar laminectomy with fusion were obtained from the literature. A break-even analysis was then performed to determine the absolute risk reduction (ARR) in infection rate to make prophylactic application of vancomycin powder cost-effective. Analysis of lumbar laminectomy with fusion was performed for comparison. Results: Costing $3.06 per gram at our institution, vancomycin powder was determined to be cost-effective in lumbar laminectomy if the infection rate of 4.2% decreased by an ARR of 0.015%. Laminectomy with fusion was also determined to be cost-effective at the same cost of vancomycin powder if the infection rate of 8.5% decreased by an ARR of 0.0034%. The current highest cost reported in the literature, $44.00 per gram of vancomycin powder, remained cost-effective with ARRs of 0.21% and 0.048% for laminectomy and laminectomy with fusion, respectively. Varying the baseline infection rate did not influence the ARR for either procedure when the analysis was performed using the product cost of vancomycin at our institution. Conclusions: This break-even analysis demonstrates that prophylactic vancomycin powder can be highly cost-effective for lumbar laminectomy. At our institution, vancomycin powder is economically justified if it prevents at least one infection out of 6700 lumbar laminectomy surgeries.

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“…Several studies suggest its potential effectiveness; however, additional higher-level evidence is warranted. 87,94…”

Section: Wound Infectionmentioning

confidence: 99%

Treatment of adult thoracolumbar spinal deformity: past, present, and future

Smith

Shaffrey

Ames

et al. 2019

Journal of Neurosurgery: Spine

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Care of the patient with adult spinal deformity (ASD) has evolved from being primarily supportive to now having the ability to directly treat and correct the spinal pathology. The focus of this narrative literature review is to briefly summarize the history of ASD treatment, discuss the current state of the art of ASD care with focus on surgical treatment and current challenges, and conclude with a discussion of potential developments related to ASD surgery.In the past, care for ASD was primarily based on supportive measures, including braces and assistive devices, with few options for surgical treatments that were often deemed high risk and reserved for rare situations. Advances in anesthetic and critical care, surgical techniques, and instrumentation now enable almost routine surgery for many patients with ASD. Despite the advances, there are many remaining challenges currently impacting the care of ASD patients, including increasing numbers of elderly patients with greater comorbidities, high complication and reoperation rates, and high procedure cost without clearly demonstrated cost-effectiveness based on standard criteria. In addition, there remains considerable variability across multiple aspects of ASD surgery. For example, there is currently very limited ability to provide preoperative individualized counseling regarding optimal treatment approaches (e.g., operative vs nonoperative), complication risks with surgery, durability of surgery, and likelihood of achieving individualized patient goals and satisfaction. Despite the challenges associated with the current state-of-the-art ASD treatment, surgery continues to be a primary option, as multiple reports have demonstrated the potential for surgery to significantly improve pain and disability. The future of ASD care will likely include techniques and technologies to markedly reduce complication rates, including greater use of navigation and robotics, and a shift toward individualized medicine that enables improved counseling, preoperative planning, procedure safety, and patient satisfaction.Advances in the care of ASD patients have been remarkable over the past few decades. The current state of the art enables almost routine surgical treatment for many types of ASD that have the potential to significantly improve pain and disability. However, significant challenges remain, including high complication rates, lack of demonstrated cost-effectiveness, and limited ability to meaningfully counsel patients preoperatively on an individual basis. The future of ASD surgery will require continued improvement of predictability, safety, and sustainability.

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Prophylaxis of surgical site infection in adult spine surgery: A systematic review

Cited by 40 publications

References 144 publications

Light‐Activated Tissue‐Integrating Sutures as Surgical Nanodevices

Light‐Activated Tissue‐Integrating Sutures as Surgical Nanodevices

The Cost-Effectiveness of Vancomycin Powder in Lumbar Laminectomy

Treatment of adult thoracolumbar spinal deformity: past, present, and future

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