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Surgical site infection prophylaxis with intra-wound vancomycin powder for uninstrumented spine surgeries: a meta-analysis

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Abstract

Purpose

It is unclear if intra-wound vancomycin powder significantly reduces the infection rate for uninstrumented spine surgery. The purpose of this study is to compare the rate of surgical site infection (SSI) in uninstrumented spine surgery that used vancomycin powder against controls.

Methods

A search was performed on PUBMED/MEDLINE, Cochrane Database and Embase on 14 October 2022. Search keywords were “vancomycin, spine surgery, uninstrumented and spinal surgery.” Instrumented cases were excluded. Type of surgery, type of treatment and incidence of infection among experimental or control were recorded.

Results

288 articles were obtained from a literature search. 16 studies met inclusion criteria. 6/16 studies that reported on the infection rate using vancomycin were obtained.

There were 1376 control cases with 20 cases of post-operative infection (1.45% overall). There were 795 cases that received prophylactic intra-wound vancomycin powder with 10 cases of infection reported (1.26%). There was no significant difference in infections between cases that received vancomycin compared to control. On subgroup analysis, studies that had a high rate of infection (Strom and Cannon) had a significant difference on the rate of infection with the use of vancomycin compared to control.

Discussion and conclusion

The current study was unable to conclude that vancomycin decreased the rate of surgical site infections. Vancomycin use may be useful in populations that have a high rate of infection. Limitations in this study include the small number of studies that report on the use of vancomycin on uninstrumented spine surgery.

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Acknowledgments

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Funding

This research received no external funding.

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Authors and Affiliations

  1. Tripler Army Medical Center, 1 Jarrett White Rd. Medical Center, Honolulu, HI, 96859, USA

    Connor Zale & JMatthew Cage

  2. William Beaumont Army Medical Center, 18511 Highlander Medics St., Fort Bliss, TX, 79918, USA

    Marc Nicholes

  3. Stanford University, 450 Broadway Street MC6342, Redwood City, CA, 94063, USA

    Serena Hu

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  1. Connor Zale
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  3. Serena Hu
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  4. JMatthew Cage
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Correspondence to Connor Zale.

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Conflict of interest

There are no disclosures or conflicts of interest from the authors related to this publication. Serena Hu has stock in Nuvasive. She has board positions in SRS and AOA and she has an editorial position at the Global Spine Journal. The views expressed in this abstract/manuscript are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

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Zale, C., Nicholes, M., Hu, S. et al. Surgical site infection prophylaxis with intra-wound vancomycin powder for uninstrumented spine surgeries: a meta-analysis. Eur Spine J 32, 4259–4264 (2023). https://doi.org/10.1007/s00586-023-07897-w

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  • DOI: https://doi.org/10.1007/s00586-023-07897-w

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