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Does the use of intrawound povidone-iodine irrigation and local vancomycin powder impact surgical site infection rate in adolescent idiopathic scoliosis surgery?

Abstract

Purpose

Surgical site infection (SSI) is a major complication after adolescent idiopathic scoliosis (AIS) surgery, with an incidence ranging from 0.5 to 7%. Intraoperative wound decontamination with povidone-iodine (PVP-I) irrigation and/or vancomycin powder in adult spinal surgery has gained attention in the literature with controversial results. The aim of this study was to investigate the impact of using intrawound PVP-I irrigation and local vancomycin powder (LVP) on the incidence of early SSI in AIS surgery.

Methods

All AIS patients who underwent posterior spinal fusion between October 2016 and December 2019 were retrospectively reviewed. The incidence of early SSI was reported and compared between 2 groups defined by the treating spinal surgeons’ preferences: group 1—intrawound irrigation with 2L of PVP-I and application of 3 g LVP before closure and control group 2—patients that did not receive either of these measures.

Results

Nine early cases of SSI (2.9%) were reported among the 307 AIS posterior spinal fusion patients. Incidence of SSI in group 1 (2/178 = 1.1%) was significantly lower than in group 2 (7/129 = 5.4%; p = 0.04). There were no adverse reactions to the use of PVP-I and LVP in our study. At latest follow-up, rate of surgical revision for mechanical failure with pseudarthrosis was significantly lower in group 1 (2/178 = 1.1%) than in group 2 (9/129 = 7.0%; p = 0.01).

Conclusion

Intraoperative use of intrawound PVP-I irrigation and vancomycin powder is associated with a significant reduction of early SSI after AIS spine surgery.

Level of evidence IV

Retrospective study.

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Availability of data and material

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

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Authors and Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by V. Meissburger and C. Mallet. B. Ilharreborde, A. Happiette and S.Bonacorsi participated in the study design and manuscript revision. J. Chinnappa participated in manuscript writeup and revision. AL. Simon participated in study design, manuscript revision, data interpretation and statistical analysis. Each author has given final approval of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Cindy Mallet.

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Conflict of interest

Pr B. Ilharreborde reports personal fees and consulting for ZimmerSpine, Implanet and Medtronic, unrelated to the submitted work. The other authors have no conflicts of interest to declare.

Ethics approval

Ethics approval was waived by the local Ethics Committee of University Paris Diderot in view of the retrospective nature of the study, and all the procedures being performed were part of the routine care.

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Verbal informed consent was obtained from patients included in the study.

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Mallet, C., Meissburger, V., Caseris, M. et al. Does the use of intrawound povidone-iodine irrigation and local vancomycin powder impact surgical site infection rate in adolescent idiopathic scoliosis surgery?. Eur Spine J (2022). https://doi.org/10.1007/s00586-022-07340-6

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  • DOI: https://doi.org/10.1007/s00586-022-07340-6

Keywords

  • Adolescent idiopathic scoliosis
  • Surgical site infection
  • Vancomycin powder
  • Povidone-iodine irrigation