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Topical Vancomycin in Pediatric Spine Surgery Does Not Reduce Surgical Site Infection: A Retrospective Cohort Study

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Abstract

Study Design

Retrospective cohort study.

Objectives

Evaluate the effectiveness of topical vancomycin in reducing surgical site infection (SSI) in pediatric patients undergoing posterior spinal fusion (PSF).

Summary of Background Data

There has been increased interest in use of topical vancomycin to reduce SSI in spine surgery with mixed results reported in the literature. In Summer 2012, our institution implemented the use of topical vancomycin in definitive primary and revision PSF as part of our infection control protocol.

Methods

After IRB approval, a consecutive series of 527 patients (538 procedures) undergoing PSF January 2010-December 2014 were retrospectively reviewed to identify the occurrence of SSI. Based on published results from a similar study, an a priori power analysis determined 190 patients were needed per group to achieve 0.90 power. In 228 procedures, topical vancomycin was used (Vanco) and in 310 procedures it was not (No Vanco). Exclusion criteria were <90 days follow-up, >18 years at time of surgery, and combined anterior and posterior fusion. Two-sample t tests, Wilcoxon rank-sum tests, and Fisher exact tests were used to compare the cohorts.

Results

Groups were similar in age, sex, implant density, fusion length, risk categorization, and surgical time (p > .05). No Vanco had significantly higher blood loss and incidence and amount of intraoperative allogenic transfusion (p < .001). Incidence of SSI was 3% (7/228) in Vanco and 2% (6/310) in No Vanco (p = .4099). Six of the 7 SSIs occurred in high-risk patients in Vanco and 5 of 6 occurred in high-risk patients in No Vanco (p = 1). Reoperation within 90 days was 6% (13/228) in Vanco and 4% (11/310) in No Vanco (p = .2912). Occurrence of other complications was similar between Vanco, 3% (7/228), and No Vanco, 2% (5/310).

Conclusion

Use of topical vancomycin did not reduce incidence of SSI for pediatric patients undergoing PSF at our institution.

Level of Evidence

Level III.

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Author information

Authors and Affiliations

  1. Orthopaedics Institute, Children’s Hospital Colorado, 13123 East 16th Ave, Aurora, CO, 80045, USA

    Sumeet Garg MD, Courtney O’Donnell MD & Mark Erickson MD

  2. Musculoskeletal Research Center, Children’s Hospital Colorado, 13123 East 16th Ave, Aurora, CO, 80045, USA

    Nikki Bloch BA, Morgan Potter BA, Hannah Quick BA & Nicole Michael BA

  3. Department of Pediatrics, School of Medicine, University of Colorado Denver, AMC Building 500, Mail Stop C243, 13001 E. 17th Place, Aurora, CO, 80045, USA

    Claire Palmer MS

Authors
  1. Sumeet Garg MD
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  2. Nikki Bloch BA
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  3. Morgan Potter BA
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  4. Hannah Quick BA
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  5. Claire Palmer MS
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  6. Nicole Michael BA
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  7. Courtney O’Donnell MD
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  8. Mark Erickson MD
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Corresponding author

Correspondence to Sumeet Garg MD.

Additional information

SG (personal fees from Medtronic, Robert P Schuster, Decision Support in Medicine, and Mighty Oak Medical, outside the submitted work), NB (none), MP (none), HQ (none), CP (none), NM (none), CO (none), ME (other from POSNA Board of Directors, personal fees from Biomet, outside the submitted work).

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Garg, S., Bloch, N., Potter, M. et al. Topical Vancomycin in Pediatric Spine Surgery Does Not Reduce Surgical Site Infection: A Retrospective Cohort Study. Spine Deform 6, 523–528 (2018). https://doi.org/10.1016/j.jspd.2018.01.010

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  • DOI: https://doi.org/10.1016/j.jspd.2018.01.010

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