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.