Surgical Site Infection Prophylaxis and Wound Management in Spine Surgery

White, Alexandra; Jarrah, Ryan; Momin, Arbaz; Rasouli, Jonathan

doi:10.31616/asj.2020.0674

Cited by 20 publications

(24 citation statements)

References 95 publications

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“…Staphylococcus aureus cultures in the nasal cavities, preoperative chlorhexidine showers, antibacterial treatments in the surgical sites, preoperative intravenous antibiotic prophylaxes, intraoperative temperature monitoring, intrawound vancomycin, postoperative drainage, and other measures are used to prevent DSSI. 12 Intravenous vancomycin is effective in preventing infections with methicillin-resistant Staphylococcus aureus (MRSA); however, this treatment is not routinely adopted because it is associated with hypotension, ototoxicity, nephrotoxicity, and an increased risk in the development of drug-resistant microorganisms in the oropharyngeal, respiratory, and urogenital tract. 13 Due to vancomycin being absorbed into the blood from the wound with very poor efficiency and not detected in the serum of most patients, the risk of development of drug-resistant microorganisms in the oropharyngeal, gastrointestinal, and respiratory tracts is low, and high concentrations of vancomycin in the surgical site, which can effectively inhibit the growth of bacteria, may help prevent DSSI.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin Use in Posterior Lumbar Interbody Fusion of Deep Surgical Site Infection

Wang¹,

Yao²,

Li³

et al. 2022

IDR

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Objective To retrospectively analyze if the use of topical intraoperative vancomycin powder reduces deep surgical site infection (DSSI) after posterior lumbar interbody fusion. Methods All spinal surgeries for lumbar degenerative disease and underwent posterior fixation interbody fusion between January 2013 and December 2018 were reviewed. A total of 891 patients were included, of which 527 patients (treatment group) received intraoperatively topical vancomycin powder; the others were served as control group. The primary outcomes were the overall incidence of DSSI and the effect of vancomycin on its development. The secondary outcome was risk factors for DSSI. Data on the baseline characteristics, postoperative complications, perioperative risk factors, and one-year postoperative prognoses were extracted from the medical records. Results A total of 20 patients met the diagnostic criteria for DSSI (2.24%), of which 7 patients (1.33%) in the treatment group and 13 patients (3.57%) in the control group. There was a significant difference in the incidence of DSSI between the groups ( P = 0.026). Multivariate logistic regression analysis with stepwise backward elimination showed that the local use of vancomycin powder was an independent protective factor for DSSI (odds ratio ( OR ): 0.25, P = 0.01), whereas high body mass index (BMI) ( OR : 1.21, P = 0.005), drinking ( OR : 5.19, P = 0.005), urinary tract infections ( OR : 4.49, P = 0.021), diabetes mellitus ( OR : 4.32, P = 0.03), and blood transfusions ( OR : 3.67, P = 0.03) were independent risk factors for DSSI. Conclusion The intraoperative usage of vancomycin powder could reduce effectively decreases the incidence of DSSI after posterior lumbar interbody fusion for degenerative lumbar diseases. High BMI, diabetes mellitus, drinking, and urinary tract infections were independent risk factors for DSSI, whereas the local use of vancomycin protected against these factors.

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Section: Discussionmentioning

confidence: 99%

Vancomycin Use in Posterior Lumbar Interbody Fusion of Deep Surgical Site Infection

Wang¹,

Yao²,

Li³

et al. 2022

IDR

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“…The risk factors for postoperative infection can be largely divided into patient and surgical factors, including revision surgery, infectivity in other areas, diabetes, smoking, obesity, malnutrition, poor immune function, and long–term hospitalization before surgery [ 1 , 33 , 34 , 35 ]. In this study, smoking showed a statistically significant difference.…”

Section: Discussionmentioning

confidence: 99%

Is Vancomycin More Effective than Taurolidine? Comparative Analysis of Their Preventive Effect against Spinal Infection in 1000 Patients with Spinal Fusion

et al. 2022

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This study aimed to examine the effect of taurolidine irrigation on preventing surgical site infection by comparing the spinal infection rate after spinal fusion surgery using vancomycin powder application and taurolidine irrigation. Of 1081 participants, 369 underwent taurolidine irrigation, 221 underwent vancomycin powder application, and 491 were controls. Of the 20 surgical site infections (1.85%), 14 occurred in the control group (2.85%), 5 in the vancomycin group (2.26%), and 1 (0.27%) in the taurolidine group. Among the various variables, age at the time of surgery, smoking, surgical site, and hemovac removal time were significant in the univariate logistic regression. The final result was derived after variable selection using the stepwise method. In the univariate model, the odds ratios were 0.09 and 0.79 in each of the vancomycin and taurolidine groups compared to that of the control group. In the multivariate model, the odds ratios were 0.09 and 0.83 in each of the vancomycin and taurolidine groups compared to that of the control group. The preventive effect of vancomycin powder application was not statistically significant. However, the vancomycin group showed a less effective tendency than the taurolidine group. Taurolidine irrigation may be a good substitute for the vancomycin powder application.

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“…41 Obese neuromuscular patients undergoing posterior fusion have higher odds of experiencing adverse outcomes, particularly surgical site infections, urinary tract infections, and readmissions. 42, 43 Toll et al 44 reported a perioperative complication rate of 27% in 102 cases of neuromuscular scoliosis at a single center. They suggested a preexisting pulmonary compromise and greater intraoperative blood loss as the greatest risk factors for a major perioperative complication.…”

Section: A C C E P T E D a R T I C L E 10mentioning

confidence: 99%

“…Another concern is a risk factor about the postoperative complication [ 42 ]. Obese neuromuscular patients undergoing posterior fusion have higher odds of experiencing adverse outcomes, particularly surgical site infections, urinary tract infections, and readmissions [ 43 , 44 ]. Toll et al [ 45 ] reported a perioperative complication rate of 27% in 102 cases of neuromuscular scoliosis at a single center.…”

Section: Outcomes and Complications After Surgerymentioning

confidence: 99%

Clinical Issues in Indication, Correction, and Outcomes of the Surgery for Neuromuscular Scoliosis: Narrative Review in Pedicle Screw Era

2022

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Surgical treatment for neuromuscular scoliosis has evolved with pedicle screw instrumentation and the improvement of perioperative management. We aimed to review recent papers related to posterior surgical correction with a pedicle screw system for neuromuscular scoliosis, particularly cerebral palsy and muscular dystrophy, in terms of indication, correction method, and outcomes. The most remarkable change was the posterior-only operation with all pedicle screw fixations. With this change, operation time, blood loss, and postoperative complications decreased. Furthermore, spinal osteotomy could be performed with the pedicle screw system for severe scoliosis. S2-alar-iliac screws demonstrated favorable outcomes in terms of stability and complication, but a question remains about saving the mobile segment for sitting balance, interaction between the hip and spine, effect to the sagittal balance, and proximal junctional problem. The quality of life improvement was more definite in patients with cerebral palsy. The improvement of respiratory function in Duchenne muscular dystrophy was not certain, although an increase of spinal height, thoracic cavity size, and absolute forced vital capacity have been reported. Further prospective studies or randomized clinical trials are needed to evaluate the long-term outcomes of lumbosacral fixation, preservation of the lumbosacral joint, or functional improvement considering the different etiology.

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Surgical Site Infection Prophylaxis and Wound Management in Spine Surgery

Cited by 20 publications

References 95 publications

Vancomycin Use in Posterior Lumbar Interbody Fusion of Deep Surgical Site Infection

Vancomycin Use in Posterior Lumbar Interbody Fusion of Deep Surgical Site Infection

Is Vancomycin More Effective than Taurolidine? Comparative Analysis of Their Preventive Effect against Spinal Infection in 1000 Patients with Spinal Fusion

Clinical Issues in Indication, Correction, and Outcomes of the Surgery for Neuromuscular Scoliosis: Narrative Review in Pedicle Screw Era

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