The Efficacy of Prophylactic Vancomycin in Decreasing Surgical Site Infections in Adolescent Idiopathic Scoliosis Patients: A Large Multicenter Cohort Study.

Abstract

Background: The use of vancomycin powder in spine surgery has been supported in adult populations, however, its efficacy in preventing postoperative surgical site infections in AIS patients is yet to be determined.

Methods: A multi-center review was conducted from June 2010 to February 2019, using ICD and CPT codes to identify AIS patients who underwent primary PSF. The patients were divided into two groups: the vancomycin cohort (receiving local vancomycin powder prior to wound closure) and the non-vancomycin cohort. Demographic and surgical data, microbial data, and SSI rates were compared between the two groups.

Results: A total of 1,917 AIS patients underwent PSF during the study period. There were no significant differences in age at surgery, BMI, sex, or presence of osteotomy between the two groups. The vancomycin cohort had 65.3% patients (n=1,252) with 0.5% (n=6) diagnosed SSIs, while the non-vancomycin cohort had 34.7% patients (n=665) with 0.8% (n=5) SSIs (p=0.451). Four (66.7%) gram-negative bacteria were isolated in the vancomycin cohort, compared to one (20%) in the non-vancomycin cohort.

Conclusion: The results showed no significant reduction in surgical site infections with the use of prophylactic, local vancomycin in AIS patients undergoing PSF (0.5% versus 0.8%). Further studies are needed to fully assess the effectiveness of vancomycin in this population. Level of Evidence: III.