Meza Blake C, Talwar Divya, Flynn John M
The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
Spine Deform. 2020 Feb;8(1):45-50. doi: 10.1007/s43390-020-00033-4. Epub 2020 Jan 24.
Retrospective descriptive, single-center study.
To determine the effect of standardized intrawound vancomycin powder and betadine irrigation on surgical site infection (SSI) rates after posterior spinal fusion (PSF) in idiopathic scoliosis. Since 2005, our pediatric spine center has implemented a series of changes to lower the risk of SSI. The most recent interventions-intrawound vancomycin powder and betadine irrigation-are applied just before closure, aiming to reduce the culture-positive bacterial contamination known to occur in many cases. We sought to determine the impact of these end-of-case measures on our center's SSI rate.
We retrospectively reviewed patients who underwent PSF for idiopathic scoliosis at our institution from January 1, 2010, to June 30, 2018, identifying all cases that returned to the operating room for surgical debridement within 90 days of PSF. Cases were surgeon-audited to ensure inclusion of all infections that met Centers for Disease Control and Prevention (CDC) criteria for acute SSI. Vertical expandable prosthetic titanium ribs, growing rods, staged procedures, and nonidiopathic cases were excluded. Annual rates of SSIs were correlated with the initiation of each SSI prevention measure.
Among 740 cases of PSF for idiopathic scoliosis from 2010 to 2018, the overall acute SSI rate by CDC criteria was 0.68%. The idiopathic SSI rate dropped significantly, from 1.70 to 0.20%, after the standardized introduction of intrawound vancomycin powder and betadine irrigation before closure (p < 0.04). The implementation of these end-of-case measures in 2012-2013 was soon followed by an institution best 3.5-year SSI-free period for idiopathic cases.
Since intrawound vancomycin powder and betadine irrigation were added to our SSI prevention bundle, we have seen a significantly lower SSI rate after PSFs for idiopathic scoliosis. These findings suggest that anti-SSI interventions to reduce wound contamination at the end of the case may have a particularly positive impact on SSI reduction.
Level III, therapeutic.
回顾性描述性单中心研究。
确定标准化的伤口内万古霉素粉末和碘伏冲洗对特发性脊柱侧弯后路脊柱融合术（PSF）后手术部位感染（SSI）发生率的影响。自2005年以来，我们的小儿脊柱中心实施了一系列降低SSI风险的措施。最新的干预措施——伤口内万古霉素粉末和碘伏冲洗——在关闭切口前应用，旨在减少许多病例中已知的培养阳性细菌污染。我们试图确定这些病例结束时的措施对我们中心SSI发生率的影响。
我们回顾性分析了2010年1月1日至2018年6月30日在我院接受特发性脊柱侧弯PSF手术的患者，确定了所有在PSF术后90天内返回手术室进行手术清创的病例。病例由外科医生审核，以确保纳入所有符合疾病控制与预防中心（CDC）急性SSI标准的感染病例。排除垂直可扩张人工钛肋、生长棒、分期手术和非特发性病例。每年的SSI发生率与每项SSI预防措施的启动相关。
在2010年至2018年的740例特发性脊柱侧弯PSF病例中，根据CDC标准，总体急性SSI发生率为0.68%。在标准化引入伤口内万古霉素粉末和关闭切口前碘伏冲洗后，特发性SSI发生率从1.70%显著降至0.20%（p < 0.04）。2012 - 2013年实施这些病例结束时的措施后，紧接着是机构内特发性病例最佳的3.5年无SSI期。
自从在我们的SSI预防方案中增加伤口内万古霉素粉末和碘伏冲洗后，我们发现特发性脊柱侧弯PSF术后的SSI发生率显著降低。这些发现表明，在病例结束时减少伤口污染的抗SSI干预措施可能对降低SSI有特别积极的影响。
三级，治疗性。
