Efficacy of the local application of different doses of vancomycin in the prevention of surgical site infections after lumbar fusion surgery
Objective:To evaluate the efficacy of local application of different doses of vancomycin for the prevention of surgical site infections(SSIs)after lumbar fusion surgery.Methods:Clinical data of 180 patients who underwent posterior lumbar fusion for lumbar degenerative disease from March 2019 to August 2022 were retrospectively analyzed.Fifty-eight patients received conventional perioperative infection prevention regimen(conventional group);122 patients received conventional perioperative infection prevention regimen combined with local application of either 0.5 g vancomycin powder(0.5 g vancomycin group,62 patients)or 1.0 g vancomycin powder(1.0 g vancomycin group,60 patients).Postoperative C-reactive protein(CRP)levels,erythrocyte sedimentation rate(ESR),visual analogue score(VAS)for pain,and Japanese Orthopedic Association(JOA)scores for lumbar spine were compared among the three groups,and the occurrence of complications was also recorded.Results:No postoperative SSIs occurred in the 1.0 g vancomycin group,while one patient(1.6％)in the 0.5 g vancomycin group had a postoperative non-staphylococcal infection,and five patients(8.6％)in the conventional group developed postoperative SSIs,with a statistically significant difference in the incidence of SSIs between the conventional group and the 1.0 g vancomycin group(P＜0.05).At 1 week postoperatively,patients in the 0.5 g or 1.0 g vancomycin group had lower CRP levels and ESR compared to those in the conventional group(both P＜0.05),and the differences in CRP level and ESR between the 1.0 g vancomycin group and the 0.5 g vancomycin group were statistically significant(both P＜0.05).At 1 week and 1 month postoperatively,patients in the 0.5 g or 1.0 g vancomycin group had lower VAS scores for pain and higher JOA scores compared to those in the conventional group(all P＜0.05).None of the patients in the vancomycin group experienced drug-related adverse reactions.Conclusions:Local application of 0.5 g or 1.0 g of vancomycin powder during lumbar fusion surgery can significantly reduce the incidence of SSIs.The local application of 1.0 g of vancomycin can better reduce the level of postoperative inflammation and improve postoperative outcomes in patients.
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