NEW ORLEANS — Results presented at the AAP National Conference & Exhibition showed use of intrawound vancomycin powder and betadine irrigation at the end of posterior spinal fusion significantly lowered the surgical site infection rate in patients with idiopathic scoliosis.
“It is important to note that it is not necessarily the case for all types of scoliosis, such as neuromuscular or other types of non-idiopathic scoliosis, because these patients have different risk factors for infection and the antibiotics might not necessarily cover the bacteria that they are more susceptible to be infected by,” Blake Meza, fourth-year medical student at the Perelman School of Medicine at the University of Pennsylvania and Children’s Hospital of Philadelphia, told Healio.com/Orthopedics.
Meza and colleagues reviewed the case history of 740 patients with idiopathic scoliosis who underwent posterior spinal fusions and identified patients who had possible infection within 90 days after surgery.
“We then determined the annual ... surgical site infection rate from 2010 to 2018 and plotted it over time, with 2013 denoting the before and after [implementation of] ... intrawound vancomycin powder and copious betadine irrigation at the end of the case,” Meza said.
From 2010 to 2018, the researchers identified an infection rate of 0.68%. Meza noted a statistically significant improvement in the surgical site infection rate from before and after implementation of the intervention of 1.7% to 0.2%.
“Additionally, there was a 3.5-year period after the measures were implemented where there were no infections,” Meza said.
However, Meza noted these results may differ depending on the local biomes, OR environment and surgeon habits that exist across sites and within individual institutions.
“Nonetheless, we think there are some benefits to these end-of-case measures because the literature has shown there is a clear high rate of contamination about one-third of the time in cases,” Meza said. “By putting in [vancomycin powder or betadine irrigation] at the end, that can prevent contamination from becoming a spine infection, which is very important.” – by Casey Tingle
Flynn J, et al. Surgical site infection prevention after posterior spinal fusion: It’s the end that counts. Presented at: AAP National Conference & Exhibition; Oct. 25-29, 2019; New Orleans.
Disclosure: Meza reports no relevant financial disclosures.