Vancomycin Effectiveness in Reducing Surgical Site Infection in Posterior Spinal Fusion Surgery: A Retrospective Data Analysis of the STRIVE Trial.
Aditya Joshi, Ryan M Schiedo, Rachel S Bronheim et al.
✦ AI-curated · Sources linked
In 30 seconds
This retrospective analysis of prospectively collected data from the STRIVE trial examined intrawound vancomycin use and outcomes after posterior spinal fusion. Among 3311 patients who underwent surgery, 847 received intrawound vancomycin alone and 1534 received no intrawound antibiotics. Vancomycin use was not associated with SSI incidence compared with no intrawound antibiotics (OR 0.77; 95% CI: 0.42-1.42). It was associated with higher odds of hospital readmission and reoperation, although the observational analysis cannot establish that vancomycin caused these outcomes.
Key findings
- SSI developed in 60 patients (8%); vancomycin use was not associated with SSI versus no intrawound antibiotics (OR 0.77; 95% CI: 0.42-1.42).
- Vancomycin use was associated with increased odds of hospital readmission (OR: 1.82; 95% CI: 1.28-2.6; P < 0.001).
- Vancomycin use was associated with increased odds of reoperation (OR: 1.75; 95% CI: 1.18-2.6; P = 0.005).
- No association was found with critical care stay (OR: 0.94; 95% CI: 0.78-1.12) or sepsis (OR: 2.04; 95% CI: 0.62-6.73).
Why it matters
Intrawound vancomycin is used to prevent infection after spinal surgery, but this analysis did not find lower SSI incidence among posterior fusion patients receiving it. The associations with readmission and reoperation also warrant attention, while requiring cautious interpretation because treatment was not randomly assigned in this analysis. These findings add evidence relevant to evaluating the benefits and potential trade-offs of this preventive approach.
What to keep in mind
This was a retrospective analysis of prospectively collected data, with vancomycin use not randomly assigned in the analysis; associations with readmission and reoperation therefore do not establish causation.