Abstract
Introduction
Patients with Early Onset Scoliosis (EOS) who require growth-friendly spine surgery are known to be at high risk for infections and/or wound dehiscence. Several studies in pediatric and adult patients undergoing spine surgery have shown that vancomycin powder applied to the wound before closure significantly reduces the risk of post-operative infection. There are currently no studies that evaluate the efficacy of intra-wound vancomycin in reducing infection for patients undergoing growth-friendly spine surgery.
Methods
Data from 116 patients in a prospectively collected database with EOS of multiple diagnoses were reviewed. Patients were divided into two groups. From May 2002 through June 2013, there were 1036 VEPTR procedures in which no patient received intra-wound vancomycin. Beginning in June 2013, there were 161 consecutive EOS procedures having VEPTR surgery and all had intra-wound vancomycin powder. Patient groups were compared based on age, gender, diagnosis, type of surgery, ambulatory status, and bowel/bladder incontinence. Additionally, complications related to intra-wound vancomycin powder were reviewed.
Results
The pre- and post-vancomycin groups were similar with regard to age, gender, diagnosis, ambulatory status, and bowel/bladder incontinence. The groups were significantly different with regard to type of surgery (Table 1). Prior to the use of intra-wound vancomycin, the infection rate in VEPTR surgery was 5.7%. The patients receiving intra-wound vancomycin had a significantly reduced infection rate of 1.2%. (p < 0.031). Using multivariate logistic generalized estimating equation model to control for surgery type, infection rate was lower in the patients who received intra-wound vancomycin as compared with the patients who did not receive intra-wound vancomycin (1.2% versus 4.4%, p = 0.066). There were no complications related to the administration of intra-wound vancomycin.
Conclusion
Intra-wound vancomycin is safe and reduces infection rates for patients undergoing growth-friendly spine surgery.