Abstract
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.
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Availability of data and material
The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by V. Meissburger and C. Mallet. B. Ilharreborde, A. Happiette and S.Bonacorsi participated in the study design and manuscript revision. J. Chinnappa participated in manuscript writeup and revision. AL. Simon participated in study design, manuscript revision, data interpretation and statistical analysis. Each author has given final approval of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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Pr B. Ilharreborde reports personal fees and consulting for ZimmerSpine, Implanet and Medtronic, unrelated to the submitted work. The other authors have no conflicts of interest to declare.
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Ethics approval was waived by the local Ethics Committee of University Paris Diderot in view of the retrospective nature of the study, and all the procedures being performed were part of the routine care.
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Mallet, C., Meissburger, V., Caseris, M. et al. Does the use of intrawound povidone-iodine irrigation and local vancomycin powder impact surgical site infection rate in adolescent idiopathic scoliosis surgery?. Eur Spine J 31, 3020–3028 (2022). https://doi.org/10.1007/s00586-022-07340-6
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DOI: https://doi.org/10.1007/s00586-022-07340-6