Intra-wound Vancomycin Powder for Surgical Site Infection Prophylaxis in Spinal Surgery: A Systematic Review and Meta-analysis.
Deng Xianjun
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In 30 seconds
This systematic review and meta-analysis examined intra-wound vancomycin powder at closure versus no powder in patients undergoing spinal surgery. Fourteen comparative studies included 9,802 patients; four were randomized trials and ten were nonrandomized cohorts. Across studies, vancomycin powder was associated with lower odds of overall surgical site infection (odds ratio 0.55; 95% confidence interval 0.44 to 0.70), as well as lower odds of deep and superficial infection. The overall association was driven by nonrandomized studies and was not statistically significant when analysis was restricted to randomized trials.
Key findings
- Across 14 studies and 9,802 patients, powder use was associated with lower odds of overall surgical site infection (odds ratio 0.55; 95% confidence interval 0.44 to 0.70).
- Odds were also lower for deep infection (0.50; 0.37 to 0.68) and superficial infection (0.55; 0.32 to 0.93).
- Among the four randomized trials, the association was not statistically significant (0.73; 0.45 to 1.18).
Why it matters
Surgical site infection remains an important complication of spinal surgery despite standard preventive measures. The pooled findings suggest a possible benefit from local vancomycin, but the difference between the overall analysis and randomized-trial results highlights how study design affects confidence in the estimate. This distinction is important when interpreting evidence for an added prophylactic measure.
What to keep in mind
The overall association was driven by nonrandomized studies and was not statistically significant in the randomized-trial subgroup. The authors state that adequately powered randomized trials are still needed.