1Department of Orthopedic Surgery and.
2Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka.
J Neurosurg Spine. 2021 Jan 8;34(4):656-664. doi: 10.3171/2020.8.SPINE20992. Print 2021 Apr 1.
Surgical site infection (SSI) after posterior spinal surgery is one of the severe complications that may occur despite administration of prophylactic antibiotics and the use of intraoperative aseptic precautions. The use of intrawound vancomycin powder for SSI prevention is still controversial, with a lack of high-quality and large-scale studies. The purpose of this retrospective study using a propensity score-matched analysis was to clarify whether intrawound vancomycin powder prevents SSI occurrence after spinal surgery.
The authors analyzed 1261 adult patients who underwent posterior spinal surgery between 2010 and 2018 (mean age 62.3 years; 506 men, 755 women; follow-up period at least 1 year). Baseline and surgical data were assessed. After a preliminary analysis, a propensity score model was established with adjustments for age, sex, type of disease, and previously reported risk factors for SSI. The SSI rates were compared between patients with intrawound vancomycin powder treatment (vancomycin group) and those without (control group).
In a preliminary analysis of 1261 unmatched patients (623 patients in the vancomycin group and 638 patients in the control group), there were significant differences between the groups in age (p = 0.041), body mass index (p = 0.013), American Society of Anesthesiologists classification (p < 0.001), malnutrition (p = 0.001), revision status (p < 0.001), use of steroids (p = 0.019), use of anticoagulation (p = 0.033), length of surgery (p = 0.003), estimated blood loss (p < 0.001), and use of instrumentation (p < 0.001). There was no significant difference in SSI rates between the vancomycin and control groups (21 SSIs [3.4%] vs 33 SSIs [5.2%]; OR 0.640, 95% CI 0.368-1.111; p = 0.114). Using a one-to-one propensity score-matched analysis, 444 pairs of patients from the vancomycin and control groups were selected. There was no significant difference in the baseline and surgical data, except for height (p = 0.046), between both groups. The C-statistic for the propensity score model was 0.702. In the score-matched analysis, 12 (2.7%) and 24 (5.4%) patients in the vancomycin and control groups, respectively, developed SSIs (OR 0.486, 95% CI 0.243-0.972; p = 0.041). There were no systemic complications related to the use of vancomycin.
The current study showed that intrawound vancomycin powder was useful in reducing the risk of SSI after posterior spinal surgery by half, without adverse events. Intrawound vancomycin powder use is a safe and effective procedure for SSI prevention.
尽管预防性应用抗生素和术中无菌预防措施，但术后脊柱感染（SSI）仍是可能发生的严重并发症之一。尽管有许多关于使用万古霉素预防 SSI 的研究，但对于术中使用万古霉素粉末仍存在争议，缺乏高质量和大规模的研究。本回顾性研究使用倾向评分匹配分析的目的是阐明在脊柱手术后使用局部万古霉素粉末是否可以预防 SSI 发生。
作者分析了 2010 年至 2018 年间接受后路脊柱手术的 1261 例成年患者（平均年龄 62.3 岁；506 例男性，755 例女性；随访时间至少 1 年）。评估了基线和手术数据。初步分析后，建立了一个倾向评分模型，调整了年龄、性别、疾病类型以及先前报道的 SSI 危险因素。比较了使用局部万古霉素粉末治疗（万古霉素组）和未使用（对照组）的患者的 SSI 发生率。
在对 1261 例未匹配患者（万古霉素组 623 例，对照组 638 例）的初步分析中，两组在年龄（p=0.041）、体重指数（p=0.013）、美国麻醉医师协会分级（p＜0.001）、营养不良（p=0.001）、翻修状态（p＜0.001）、使用类固醇（p=0.019）、使用抗凝剂（p=0.033）、手术时间（p=0.003）、估计失血量（p＜0.001）和使用器械（p＜0.001）方面存在显著差异。万古霉素组和对照组的 SSI 发生率无显著差异（21 例 SSI [3.4%] vs 33 例 SSI [5.2%]；OR 0.640，95%CI 0.368-1.111；p=0.114）。使用 1:1 倾向评分匹配分析，从万古霉素组和对照组中各选择了 444 对患者。两组在基线和手术数据方面除身高（p=0.046）外，无显著差异。倾向评分模型的 C 统计量为 0.702。在评分匹配分析中，万古霉素组和对照组分别有 12 例（2.7%）和 24 例（5.4%）患者发生 SSI（OR 0.486，95%CI 0.243-0.972；p=0.041）。没有与万古霉素使用相关的全身并发症。
本研究表明，在后路脊柱手术后，局部使用万古霉素粉末可将 SSI 风险降低一半，且无不良事件发生。局部使用万古霉素粉末是预防 SSI 的一种安全有效的方法。
