Does the use of intrawound povidone-iodine irrigation and local vancomycin powder impact surgical site infection rate in adolescent idiopathic scoliosis surgery?

Autor: Mallet C; Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 boulevard sérurier, 75019, Paris, France. mallet_cindy@yahoo.fr., Meissburger V; Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 boulevard sérurier, 75019, Paris, France., Caseris M; Pediatric Infectious Disease Department, Robert Debré University Hospital, Paris Diderot University, Paris, France., Happiette A; Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 boulevard sérurier, 75019, Paris, France., Chinnappa J; Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 boulevard sérurier, 75019, Paris, France., Bonacorsi S; Microbiology Department, Robert Debré University Hospital, Paris Diderot university, Paris, France., Simon AL; Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 boulevard sérurier, 75019, Paris, France., Ilharreborde B; Pediatric Orthopedic Department, Robert Debré University Hospital, Paris Diderot University, 48 boulevard sérurier, 75019, Paris, France.
Jazyk: angličtina
Zdroj: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society [Eur Spine J] 2022 Nov; Vol. 31 (11), pp. 3020-3028. Date of Electronic Publication: 2022 Aug 01.
DOI: 10.1007/s00586-022-07340-6
Abstrakt: Purpose: Surgical site infection (SSI) is a major complication after adolescent idiopathic scoliosis (AIS) surgery, with an incidence ranging from 0.5 to 7%. Intraoperative wound decontamination with povidone-iodine (PVP-I) irrigation and/or vancomycin powder in adult spinal surgery has gained attention in the literature with controversial results. The aim of this study was to investigate the impact of using intrawound PVP-I irrigation and local vancomycin powder (LVP) on the incidence of early SSI in AIS surgery.
Methods: All AIS patients who underwent posterior spinal fusion between October 2016 and December 2019 were retrospectively reviewed. The incidence of early SSI was reported and compared between 2 groups defined by the treating spinal surgeons' preferences: group 1-intrawound irrigation with 2L of PVP-I and application of 3 g LVP before closure and control group 2-patients that did not receive either of these measures.
Results: Nine early cases of SSI (2.9%) were reported among the 307 AIS posterior spinal fusion patients. Incidence of SSI in group 1 (2/178 = 1.1%) was significantly lower than in group 2 (7/129 = 5.4%; p = 0.04). There were no adverse reactions to the use of PVP-I and LVP in our study. At latest follow-up, rate of surgical revision for mechanical failure with pseudarthrosis was significantly lower in group 1 (2/178 = 1.1%) than in group 2 (9/129 = 7.0%; p = 0.01).
Conclusion: Intraoperative use of intrawound PVP-I irrigation and vancomycin powder is associated with a significant reduction of early SSI after AIS spine surgery.
Level of Evidence Iv: Retrospective study.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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