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Intra-wound Vancomycin Powder Significantly Reduces the Risk of Infection in Growth-friendly Surgery
John T. Smith, MDJustin Haller, MDAngela Presson, Ph.D.Jessica MorganJohn Heflin, MD
University of Utah Department of OrthopedicsPrimary Children’s HospitalSalt Lake City, UT
Disclosures
JT Smith: Depuy-Synthes; Globus; Biomet; Spineguard. BOD CSF
J Haller: none A Presson: none J Morgan: none J Heflin: Medtronic, Globus
Background Management of Early Onset Scoliosis
(EOS) using ‘Growth Friendly’ techniques is associated with a significant complication rate
Infection rates with repetitive surgery reported up to 6.2%
Infections require unplanned surgeries and significantly increase risk and the cost of care
Vancomycin Powder Multiple studies in adults have shown that
vancomycin powder sprinkled into wounds reduced the rate of post-operative infection
Few studies have shown a similar effect in children who have repetitive surgery
Hypothesis Children requiring surgical treatment for
Early Onset Scoliosis (EOS), treated with intra-wound Vancomycin powder (VP) at closure will have a lower rate of post-operative infection compared to those not treated with VP.
Study Design IRB approved review of a prospectively
collected database of EOS patients requiring surgery
Patients treated without intra-wound Vancomycin powder were compared to those who were.
Primary endpoint was a post-operative infection that required surgical or medical treatment
Methods 166 consecutive patients treated with rib-based distraction growth-
friendly surgery Single center (SLC) 1261 procedures
– 1081 without intra-wound Vancomycin– 180 with intra-wound Vancomycin
Varied etiologies– Neuromuscular: 88– Syndromic: 23– Congenital: 55– Idiopathic: 39
Average dose of Vancomycin Powder: 500 mg per wound Database reviewed to determine if there was a difference in
infection rates between the two groups
Results Infection rate without Vancomycin powder
6.2%
• Infection rate with Vancomycin powder:
2.2%
Comparison of Groups
Statistical Analysis There was a 64% decrease in risk of
infection in Rib-based distraction procedures when using Vancomycin powder compared to procedures without VP.
(relative risk: 0.36; 95% CI: 0.13, 0.97, Fisher Exact Test: p=0.03)
Discussion Children with EOS requiring repetitive surgery have a
high risk of infection A risk ratio of 0.36 indicates that intra-wound
vancomycin powder reduced this risk by 64%
Conclusion We recommend the routine use intra-wound
Vancomycin powder in all growth-friendly procedures to manage EOS
Acknowledgements
The University of UtahStudy Design and Biostatistics CenterCenter for Clinical and Translational Sciencehttp://www.ccts.utah.edu/biostats/
Hiroko Matsumoto, Ph.D.