title: Intrawound Vancomycin Decreases the Risk of Surgical Site Infection After Posterior Spine Surgery: A Multicenter Analysis.
abstract: METHODS
  Secondary analysis of data from a prospective multicenter observational study.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the occurrence of surgical site infection (SSI) in patients with and without intrawound vancomycin application controlling for confounding factors associated with higher SSI after elective spine surgery.
  
  
  BACKGROUND
  SSI is a morbid and expensive complication associated with spine surgery. The application of intrawound vancomycin is rapidly emerging as a solution to reduce SSI following spine surgery. The impact of intrawound vancomycin has not been systematically studied in a well-designed multicenter study.
  
  
  METHODS
  Patients undergoing elective spine surgery over a period of 4 years at seven spine surgery centers across the United States were included in the study. Patients were dichotomized on the basis of whether intrawound vancomycin was applied. Outcomes were occurrence of SSI within postoperative 30 days and SSI that required return to the operating room (OR). Multivariable random-effect log-binomial regression analyses were conducted to determine the relative risk of having an SSI and an SSI with return to OR.
  
  
  RESULTS
  .: A total of 2056 patients were included in the analysis. Intrawound vancomycin was utilized in 47% (n = 966) of patients. The prevalence of SSI was higher in patients with no vancomycin use (5.1%) than those with use of intrawound vancomycin (2.2%). The risk of SSI was higher in patients in whom intrawound vancomycin was not used (relative risk (RR) -2.5, P < 0.001), increased number of levels exposed (RR -1.1, P = 0.01), and those admitted postoperatively to intensive care unit (ICU) (RR -2.1, P = 0.005). Patients in whom intrawound vancomycin was not used (RR -5.9, P < 0.001), increased number of levels were exposed (RR-1.1, P = 0.001), and postoperative ICU admission (RR -3.3, P < 0.001) were significant risk factors for SSI requiring a return to the OR.
  
  
  CONCLUSIONS
  The intrawound application of vancomycin after posterior approach spine surgery was associated with a reduced risk of SSI and return to OR associated with SSI.
  
  
  METHODS
  2.
authors.affiliation: Department of Orthopedics and Neurosurgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
authors.affiliation: Department of Orthopedics and Neurosurgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Silky
authors.initials: S
authors.lastname: Chotai
authors.affiliation: Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, NC.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.affiliation: Department of Orthopedics, Thomas Jefferson University and Rothman Institute, Philadelphia, PA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.affiliation: Spine Colorado, Durango, CO.
authors.forename: Jim A
authors.initials: JA
authors.lastname: Youssef
authors.affiliation: Spine Colorado, Durango, CO.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Orndorff
authors.affiliation: Department of Neurosurgery, University of Kansas Med Center, Kansas City, KS.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Arnold
authors.affiliation: Department of Neurosurgery, New York University Langone Medical Center, New York, NY.
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Frempong-Boadu
authors.affiliation: Scoliosis and Spine Tumor Center, Texas Back Institute, Texas Health Presbyterian Hospital Plano, Plano, TX.
authors.forename: Isador H
authors.initials: IH
authors.lastname: Lieberman
authors.affiliation: Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston Salem, NC.
authors.forename: Charles
authors.initials: C
authors.lastname: Branch
authors.affiliation: Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston Salem, NC.
authors.forename: Hirad S
authors.initials: HS
authors.lastname: Hedayat
authors.affiliation: Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston Salem, NC.
authors.forename: Ann
authors.initials: A
authors.lastname: Liu
authors.affiliation: Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Wang
authors.affiliation: Division of Neurological Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Isaacs
authors.affiliation: Department of Orthopedics, Rothman Institute, Thomas Jefferson University, Egg Harbor Township, NJ.
authors.forename: Kris E
authors.initials: KE
authors.lastname: Radcliff
authors.affiliation: Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, NC.
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Patt
authors.affiliation: Department of Orthopedics and Neurosurgery, Vanderbilt University Medical Center, Nashville, TN.|Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D013131:Spine / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin