title: Comparative effectiveness and cost-benefit analysis of local application of vancomycin powder in posterior spinal fusion for spine trauma: clinical article.
abstract: OBJECTIVE
  Surgical site infection (SSI) is a morbid complication with high cost in spine surgery. In this era of health care reforms, adjuvant therapies that not only improve quality but also decrease cost are considered of highest value. The authors introduced local application of vancomycin powder into their practice of posterior spinal fusion for spine trauma and undertook this study to determine the value and cost benefit of using vancomycin powder in surgical sites to prevent postoperative infections.
  
  
  METHODS
  A retrospective review of 110 patients with traumatic spine injuries treated with instrumented posterior spine fusions over a 2-year period at a single institution was performed. One group (control group) received standard systemic prophylaxis only, whereas another (treatment group) received 1 g of locally applied vancomycin powder (spread over the surgical wound) in addition to systemic prophylaxis. Data were collected on patient demographic characteristics, clinical variables, surgical variables, and 90-day morbidity. Incidence of infection was the primary outcome evaluated, and billing records were reviewed to determine total infection-related medical cost (cost of reoperation/wound debridement, medications, and diagnostic tests). The payer's cost was estimated to be 70% of the total billing cost.
  
  
  RESULTS
  A total of 110 patients were included in the study. The control (n = 54) and treatment groups (n = 56) were similar at baseline. Use of vancomycin powder led to significant reduction in infection rate (13% infection rate in the control group vs 0% in the treatment group, p = 0.02). There were no adverse effects noted from the use of vancomycin powder. The total mean cost of treating postoperative infection per patient was $33,705. Use of vancomycin powder led to a cost savings of $438,165 per 100 posterior spinal fusions performed for traumatic injuries.
  
  
  CONCLUSIONS
  The use of adjuvant vancomycin powder was associated with a significant reduction in the incidence of postoperative infection as well as infection-related medical cost. These findings suggest that use of adjuvant vancomycin powder in high-risk patients undergoing spinal fusion is a cost-saving option for preventing postoperative infections, as it can lead to cost-savings of $438,165 per 100 spinal fusions performed.
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Saniya S
authors.initials: SS
authors.lastname: Godil
authors.forename: Scott L
authors.initials: SL
authors.lastname: Parker
authors.forename: Kevin R
authors.initials: KR
authors.lastname: O'Neill
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000191:economics* / Q000379:methods* / Q000592:standards; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination / Q000191:economics / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011208:Powders / Q000008:administration & dosage; D013123:Spinal Fusion / Q000191:economics* / Q000379:methods* / Q000592:standards; D013124:Spinal Injuries / Q000188:drug therapy / Q000191:economics* / Q000601:surgery*; D013530:Surgical Wound Infection / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D011208:Powders; D014640:Vancomycin