SUMMARY
KEYWORDS:
Vancomycin; Intraoperative care/methods; Spine/surgery; Surgical wound infection/prevention & control
KEYWORDS:
Vancomycin; Intraoperative care/methods; Spine/surgery; Surgical wound infection/prevention & control
Author/year | Groups appraisals | Surgical site infection rate (N patients/Infections%); Comparisons between control (non-SSVP) and treatment groups (with SSVP) | Follow–up and general considerations |
---|---|---|---|
1. O’Neil et al.1414. O’Neill KR, Smith JG, Abtahi AM, Archer KR, Spengler DM, McGirt MJ, et al. Reduced surgical site infections in patients undergoing posterior spinal stabilization of traumatic injuries using vancomycin powder. Spine J. 2011;11(7):641-6., 2011 | Posterior spine instrumented fusions in traumatic aliments; All spinal segments | Control group: 54/13%; Treatment group: 1 g SSVP, 56/zero (p=0.02) |
Median: 25 weeks; No adverse effects |
2. Sweet et al.77. Sweet FA, Roh M, Sliva C. Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: efficacy, drug levels, and patient outcomes. Spine (Phila Pa 1976). 2011;36(24):2084-8., 2011 | Posterior spine instrumented fusions in deformity, traumatic, neoplastic aliments; Lumbar and thoracic spinal segments | Control group: 821/2.6%; Treatment group: 2 g SSVP, 911/0.2% (p<0.0001) | Average: 2.5 years; No adverse effects |
3. Pahys et al.1515. Pahys JM, Pahys JR, Cho SK, Kang MM, Zebala LP, Hawasli AH, et al. Methods to decrease postoperative infections following posterior cervical spine surgery. J Bone Joint Surg Am. 2013;95(6):549-54., 2013 | Posterior spine instrumented fusions in degenerative, deformity, traumatic, neoplastic, congenital aliments; Cervical spine | 1. Control group: IV ATB, 483/1.86%; 2. Control group: IV ATB+Skin alcohol foam + drain, 323/0.3% (p=0.047); 3. Treatment group: IV ATB+ Skin alcohol foam + drain + 500 mg SSVP, 195/zero (p=0.048) |
Minimum: 3 months; Risk factors: A BMI* of>30 kg/m2 and rheumatoid arthritis had the strongest association with acute postoperative infections No adverse effects |
4. Strom et al.1616. Strom RG, Pacione D, Kalhorn SP, Frempong-Boadu AK. Decreased risk of wound infection after posterior cervical fusion with routine local application of vancomycin powder. Spine (Phila PA 1976). 2013;38(12):991-4., 2013 | Posterior spine instrumented fusions in degenerative, infectious, traumatic, neoplastic aliments; Cervical spine, occipitocervical and cervicothoracic spinal segments | Control group: 92/10.9%; Treatment group: 1 g SSVP, 79/2.5% (p=0.0384) | Control group: Mean 4.5 years; Treatment group: Mean 2.2 years; Absence of complications; Adverse effect: pseudarthrosis: Control group 92/5.4%; Treatment group 79/5.1% (p=1.000) |
5. Strom et al.1717. Strom RG, Pacione D, Kalhorn SP, Frempong-Boadu AK. Lumbar laminectomy and fusion with routine local application of vancomycin powder: decreased infection rate in instrumented and non-instrumented cases. Clin Neurol Neurosurg. 2013;115(9):1766-9., 2013 | Posterior spine instrumented and non instrumented fusions in degenerative, infectious, traumatic, neoplastic aliments; Thoracic and lumbar spinal segments | Control group: 97/11% overall rate (non instrumented 20/10%, instrumented 77/12%, p=0.0008); Treatment group: 1 g SSVP, 156/zero overall rate (non-instrumented 68/zero, instrumented 88/zero (p=0.049) | Control group: Mean 4.5 years; Treatment group: Mean 1.9 years; Absence of complications and no adverse effects |
6. Caroom et al.1818. Caroom C, Tullar JM, Benton EG Jr, Jones JR, Chaput CD. Intrawound vancomycin powder reduces surgical site infections in posterior cervical fusion. Spine (Phila Pa 1976), 2013;38(14):1183-7., 2013 | Posterior cervical decompression Instrumented in multilevel cervical spondylotic myelopathy (CSM); Cervical spine | Control group: 72/15%; Treatment group: 1 g SSVP, 40/zero (p=0.007) | Control group: Follow-up NI; Treatment group: Minimum of 6 months, average 18 months; No adverse effects |
7. Kim et al.1919. Kim HS, Lee SG, Kim WK, Park CW, Son S. Prophylactic intrawound application of vancomycin powder in instrumented spinal fusion surgery. Korean J Spine. 2013;10(3):121-5., 2013 | Posterior, anterior and lateral approaches instrumented in degenerative, traumatic and neoplastic aliments; All spinal segments | Control group: 40/12.5%, all in posterior approaches: Treatment group: 1 g SSVP, 34/zero (p=0.033) | Follow-up: NI; Risk factor: Elderly patients No adverse effects; |
8. Godil et al.2020. Godil SS, Parker SL, O’Neill KR, Devin CJ, McGirt MJ. Comparative effectiveness and cost-benefit analysis of local application of vancomycin powder in posterior spinal fusion for spine trauma: clinical article. J Neurosurg Spine. 2013;19(3):331-5., 2013 | Posterior cervical approach instrumented in traumatic aliments; Cervical spine | Control group: 54/13% Treatment group: 1 g SSVP, 56/zero (p=0.02) | Control and treatment groups: median 25 weeks; No adverse effects |
9. Tubaki et al.1313. Tubaki VR, Rajasekaran S, Shetty AP. Effects of using intravenous antibiotic only versus local intrawound vancomycin antibiotic powder application in addition to intravenous antibiotics on postoperative infection in spine surgery in 907 patients. Spine (Phila Pa 1976). 2013;38(25):2149-55., 2013 | Open instrumented and non instrumented spine surgery; Aliment types: NI; All spinal segments | Control group: 474/1.68% Treatment group: 1 g SSVP, 433/1.61% (p>0.05) | Control and treatment groups: minimum of 12 weeks; No adverse effects |
10. Martin et al.66. Martin JR, Adogwa O, Brown CR, Bagley CA, Richardson WJ, Lad SP, et al. Experience with intrawound vancomycin powder for spinal deformity surgery. Spine (Phila Pa 1976). 2014;39(2):177-84., 2014 | Open instrumented spine surgery in deformity; Thoracolumbar and lumbar spinal segments | Control group: 150/5.3%; Treatment group: 2 g SSVP, 156/5.1% (p=0.936) | Control and treatment groups: 30 days; No adverse effects |
11. Emohare et al.2121. Emohare O, Ledonio CG, Hill BW, Davis RA, Polly DW Jr, Kang MM. Cost savings analysis of intrawound vancomycin powder in posterior spinal surgery. Spine J. 2014;14(11):2710-5., 2014 | Open instrumented and non- instrumented spine surgery; Thoracic, thoracolumbar and lumbar spinal segments | Control group: 207/NI, return-to-surgery for infection = 6.71%; Treatment group: 1 g SSVP, 96/NI, return-to-surgery = zero (p=0.0841) | Follow-up: NI; Adverse effects: NI |
12. Theologis et al.2222. Theologis AA, Demirkiran G, Callahan M, Pekmezci M, Ames C, Deviren V. Local intrawound vancomycin powder decreases the risk of surgical site infections in complex adult deformity reconstruction: a cost analysis. Spine (Phila Pa 1976). 2014;39(22):1875-80., 2014 | Open instrumented spine surgery in deformity; Thoracic, thoracolumbar and lumbar spinal segments | Control group: 64/NI, readmissions within 90 days for SSI = 10.9%; Treatment group: 2 g SSVP, 151/NI, readmissions within 90 days for SSI = 2.6% (p=0.01) | Control group: median 34 months; Treatment group: 18 months; No adverse effects |
13. Martin et al.33. Martin JR, Adogwa O, Brown CR, Kuchibhatla M, Bagley CA, Lad SP, et al. Experience with intrawound vancomycin powder for posterior cervical fusion surgery. J Neurosurg Spine. 2015;22(1):26-33., 2015 | Open posterior instrumented spine surgery in degenerative, deformity, neoplastic and traumatic aliments; Occipitocervi cal, cervical only, and cervicothoracic spinal segments | Control group: 174/6.9%; Treatment group: 2 g SSVP, 115/5.2% (p=0.053) | Control and treatment groups: 30 days; No adverse effects |
14. Scheverin et al.2323. Scheverin N, Steverlynck A, Castelli R, Sobrero D, Kopp NV, Dinelli D, et al. Prophylaxis of surgical site infection with vancomycin in 513 patients that underwent to lumbar fusion. Coluna/Columna. 2015;14(3):177-80., 2015 | Open posterior instrumented spine surgery in degenerative aliments; Lumbar spine | Control group: 281/4.98%; Treatment group: 1 g SSVP, 232/1.29% (p=0.0245) | Control and treatment groups: mean 10 months; Risks for SSI: age > 65 years, obesity, prolonged surgery, surgical blood lose; No adverse effects |
15. Tomov et al.2424. Tomov M, Mitsunaga L, Durbin-Johnson B, Nallur D, Roberto R. Reducing surgical site infection in spinal surgery with betadine irrigation and intrawound vancomycin powder. Spine (Phila Pa 1976). 2015;40(7):491-9., 2015 | Open and percutaneous, anterior and posterior, instrumented and non instrumented spine surgery in deformity, degenerative, traumatic, neoplastic aliments; All spinal segments | Control group: NI; Treatment group: 1 g SSVP, NI; SSI rates were reduced by 50% after the intervention with SSVP (p=0.042) | Follow-up: NI; Risks for SSI: anemia, prior operation, vertebral fracture; Adverse effects: NI |
16. Liu et al.2525. Liu N, Wood KB, Schwab JH, Cha TD, Puhkan RD, Osler PM, et al. Comparison of intrawound vancomycin utility in posterior instrumented spine surgeries between patients with tumor and nontumor patients. Spine (Phila Pa 1976). 2015;40(20):1586-92., 2015 | Open posterior spine surgery in degenerative, deformity, neoplastic aliments; Cervical, thoracic, lumbar spinal segments | Control group: Non-tumor, non-SSVP, 129/7%; Tumor, non-SSVP, 25/8% (p=0.011). Treatment group: Non-tumor, 0.5 mg – 2 g SSVP, 153/0.7%; Tumor, 0.5 mg – 2 g SSVP, 27/14.8% (p=0.442). |
Control and treatment groups: 3 months; Preoperative radiotherapy may contribute to the increase of SSI; No adverse effects |
17. Heller et al.2626. Heller A, McIff TE, Lai SM, Burton DC. Intrawound vancomycin powder decreases staphylococcal surgical site infections after posterior instrumented spinal arthrodesis. J Spinal Disord Tech. 2015;28(10):E584-9., 2015 | Open posterior spine surgery in degenerative, deformity, neoplastic; traumatic aliments; Cervical, thoracic, lumbar spinal segments | Control group: 341/3.89%; Treatment group: 0.5 mg-2 g SSVP, 342/1.1%; (p=0.029) | Control and treatment groups: 90 days. Risk factors for SSI: Discharge to skilled nursing or rehabilitation facilities; No adverse effects |
18. Schroeder et al.2727. Schroeder JE, Girardi FP, Sandhu H, Weinstein J, Cammisa FP, Sama A. The use of local vancomycin powder in degenerative spine surgery. Eur Spine J. 2016;25(4):1029-33., 2016 | Open posterior or anterior, non instrumented and instrumented cervical, thoracic, lumbar spine surgery (anterior cervical excluded); Spinal aliments: NI | Control group: 2253/1.33%; Treatment group: 1-1.5 g SSVP, 1224/0.40% (p=0.04) | Control and treatment groups: 12 months; Adverse effects: NI |
19. Lee et al.2828. Lee GI, Bak KH, Chun HJ, Choi KS. Effect of using local intrawound vancomycin powder in addition to intravenous antibiotics in posterior lumbar surgery: midterm result in a single-center study. Korean J Spine. 2016;13(2):47-52., 2016 | Open posterior lumbar spine surgery; Spinal aliments: NI (excluded traumatic) | Control group: 296/10.5%; Treatment group: 1 g SSVP, 275/5.5% | Control group: mean 11 months; Treatment group: mean 8 months; Risk factors: Diabetes mellitus, cardiovascular disease, and longer hospital stay; No adverse effects |
20. Hey et al.2929. Hey HW, Thiam DW, Koh ZS, Thambiah JS, Kumar N, Lau LL, et al. Is intraoperative local vancomycin powder the answer to surgical site infections in spine surgery? Spine (Phila Pa 1976). 2017;42(4):267-74., 2017 | Open posterior, lateral spinal surgery; Degenerative, developmental, traumatic, infectious, neoplastic, revision; Non-instrumented and instrumented; Cervical, thoracic, lumbar | Control group: 272/6.3%; Treatment group: 1 g SSVP, 117/0,9%; | Control and treatment groups: 3 months; Adverse effects: NI |
21. Van Hal et al.3030. Van Hal M, Lee J, Laudermilch D, Nwasike C, Kang J. Vancomycin powder regimen for prevention of surgical site infection in complex spine surgeries. Clin Spine Surg. 2017;30(8):E1062-5., 2017 | Spinal surgery (laminectomies and arthrodesis) | Control group: 652/NI; Treatment group: SSVP dose NI, 496/5.6% | Follow-up:NI |
22. Chotai et al.3131. Chotai S, Wright PW, Hale AT, Jones WA, McGirt MJ, Patt JC, et al. Does intrawound vancomycin application during spine surgery create vancomycin-resistant organism? Neurosurgery. 2017;80(5):746-53., 2017 | Open posterior and anterior spinal surgery: Degenerative, deformity, neoplastic; With and without instrumentation | Control group: 1587/2.5%; Treatment group: 1 g SSVP, 1.6% | Control and treatment groups: 1 year; No adverse effects |
Study | Selection | Comparability | Exposition | |
---|---|---|---|---|
Van Hal et al.3030. Van Hal M, Lee J, Laudermilch D, Nwasike C, Kang J. Vancomycin powder regimen for prevention of surgical site infection in complex spine surgeries. Clin Spine Surg. 2017;30(8):E1062-5., 2017 | **** | * | ** | Current vs. previous |
Martin et al.66. Martin JR, Adogwa O, Brown CR, Bagley CA, Richardson WJ, Lad SP, et al. Experience with intrawound vancomycin powder for spinal deformity surgery. Spine (Phila Pa 1976). 2014;39(2):177-84., 2014 | **** | * | ** | Current vs. previous. Use of propensity score adjustment. |
Liu et al.2525. Liu N, Wood KB, Schwab JH, Cha TD, Puhkan RD, Osler PM, et al. Comparison of intrawound vancomycin utility in posterior instrumented spine surgeries between patients with tumor and nontumor patients. Spine (Phila Pa 1976). 2015;40(20):1586-92., 2015 | **** | * | ** | Current vs. previous. Significant differences between samples. |
Tomov et al.2424. Tomov M, Mitsunaga L, Durbin-Johnson B, Nallur D, Roberto R. Reducing surgical site infection in spinal surgery with betadine irrigation and intrawound vancomycin powder. Spine (Phila Pa 1976). 2015;40(7):491-9., 2015 | **** | * | ** | Current vs. previous. Data from the Healthcare Infection Management and Infection. |
Martin et al.33. Martin JR, Adogwa O, Brown CR, Kuchibhatla M, Bagley CA, Lad SP, et al. Experience with intrawound vancomycin powder for posterior cervical fusion surgery. J Neurosurg Spine. 2015;22(1):26-33., 2015 | **** | * | ** | Current vs. previous. Significant differences between samples. |
Theologis et al.2222. Theologis AA, Demirkiran G, Callahan M, Pekmezci M, Ames C, Deviren V. Local intrawound vancomycin powder decreases the risk of surgical site infections in complex adult deformity reconstruction: a cost analysis. Spine (Phila Pa 1976). 2014;39(22):1875-80., 2014 | **** | * | ** | Current vs. previous. Significant differences between samples. |
Kim et al.1919. Kim HS, Lee SG, Kim WK, Park CW, Son S. Prophylactic intrawound application of vancomycin powder in instrumented spinal fusion surgery. Korean J Spine. 2013;10(3):121-5., 2013 | **** | * | ** | Current vs. previous. |
Strom et al.1717. Strom RG, Pacione D, Kalhorn SP, Frempong-Boadu AK. Lumbar laminectomy and fusion with routine local application of vancomycin powder: decreased infection rate in instrumented and non-instrumented cases. Clin Neurol Neurosurg. 2013;115(9):1766-9., 2013 | **** | * | ** | Current vs. previous. Imbalanced for instrumentation. |
Heller et al.2626. Heller A, McIff TE, Lai SM, Burton DC. Intrawound vancomycin powder decreases staphylococcal surgical site infections after posterior instrumented spinal arthrodesis. J Spinal Disord Tech. 2015;28(10):E584-9., 2015 | **** | * | ** | Current vs. previous. Only 8%follow-up losses Imbalanced for age, arterial hypertension and use of hair cut. |
Schroeder et al.2727. Schroeder JE, Girardi FP, Sandhu H, Weinstein J, Cammisa FP, Sama A. The use of local vancomycin powder in degenerative spine surgery. Eur Spine J. 2016;25(4):1029-33., 2016 | **** | * | ** | Current vs. previous. Significant differences between samples. |
Lee et al.2828. Lee GI, Bak KH, Chun HJ, Choi KS. Effect of using local intrawound vancomycin powder in addition to intravenous antibiotics in posterior lumbar surgery: midterm result in a single-center study. Korean J Spine. 2016;13(2):47-52., 2016 | **** | * | ** | Current vs. previous. Uni and multivariate analysis for covariates. |
Pahys et al.1515. Pahys JM, Pahys JR, Cho SK, Kang MM, Zebala LP, Hawasli AH, et al. Methods to decrease postoperative infections following posterior cervical spine surgery. J Bone Joint Surg Am. 2013;95(6):549-54., 2013 | **** | * | ** | Data collected and analyzed by three independent reviewers. Significant differences between samples. |
Hey et al.2929. Hey HW, Thiam DW, Koh ZS, Thambiah JS, Kumar N, Lau LL, et al. Is intraoperative local vancomycin powder the answer to surgical site infections in spine surgery? Spine (Phila Pa 1976). 2017;42(4):267-74., 2017 | **** | * | ** | Significant differences between samples |
Scheverin et al.2323. Scheverin N, Steverlynck A, Castelli R, Sobrero D, Kopp NV, Dinelli D, et al. Prophylaxis of surgical site infection with vancomycin in 513 patients that underwent to lumbar fusion. Coluna/Columna. 2015;14(3):177-80., 2015 | **** | * | ** | Vancomycin indicated according to the surgeon's preference. Significant differences between samples |
Godil et al.1818. Caroom C, Tullar JM, Benton EG Jr, Jones JR, Chaput CD. Intrawound vancomycin powder reduces surgical site infections in posterior cervical fusion. Spine (Phila Pa 1976), 2013;38(14):1183-7., 2013 | **** | * | ** | Samples based on surgeon preferences. Non controlled for confounders but without differences between samples. |
Chotai et al.3131. Chotai S, Wright PW, Hale AT, Jones WA, McGirt MJ, Patt JC, et al. Does intrawound vancomycin application during spine surgery create vancomycin-resistant organism? Neurosurgery. 2017;80(5):746-53., 2017 | **** | * | ** | Not controlled for confounders but without differences between samples. |
Carrom et al.1818. Caroom C, Tullar JM, Benton EG Jr, Jones JR, Chaput CD. Intrawound vancomycin powder reduces surgical site infections in posterior cervical fusion. Spine (Phila Pa 1976), 2013;38(14):1183-7., 2013 | **** | * | ** | Current vs. previous. The intervention group trended toward slightly more complex procedures. |
Sweet et al.77. Sweet FA, Roh M, Sliva C. Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: efficacy, drug levels, and patient outcomes. Spine (Phila Pa 1976). 2011;36(24):2084-8., 2011 | **** | * | ** | Current vs. previous. No significant differences between samples |
Emohare et al.2121. Emohare O, Ledonio CG, Hill BW, Davis RA, Polly DW Jr, Kang MM. Cost savings analysis of intrawound vancomycin powder in posterior spinal surgery. Spine J. 2014;14(11):2710-5., 2014 | **** | * | ** | Patient allocation-specific surgeon or on-call admission. Significant differences between samples. |
O’Neil et al.1414. O’Neill KR, Smith JG, Abtahi AM, Archer KR, Spengler DM, McGirt MJ, et al. Reduced surgical site infections in patients undergoing posterior spinal stabilization of traumatic injuries using vancomycin powder. Spine J. 2011;11(7):641-6., 2011 | **** | ** | ** | The treatment and control groups were statistically similar. |
Strom et al.1616. Strom RG, Pacione D, Kalhorn SP, Frempong-Boadu AK. Decreased risk of wound infection after posterior cervical fusion with routine local application of vancomycin powder. Spine (Phila PA 1976). 2013;38(12):991-4., 2013 | **** | ** | Current vs. previous. No significant difference between samples. |
Results for subgroups (random effects model): | ||||||
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k | OR | 95% - CI | Q | tau^2 | I^2 | |
IR = low | 3 | 0.4499 | [0.2139; 0.9461] | 2.26 | 0.056 | 11.5% |
IR = medium | 5 | 0.3612 | [0.1918; 0.6800] | 8.32 | 0.2367 | 51.9% |
IR = high | 14 | 0.3484 | [0.2252; 0.5391] | 19.99 | 0.2039 | 35.0% |