Povidone-iodine irrigation combined with Vancomycin powder lowers infection rates in pediatric deformity surgery

• Published in: Spine deformity 2021-09, Vol.9 (5), p.1315-1321
• Main Authors: Roberto, Rolando Figueroa, Rowan, Flynn Andrew, Nallur, Deepak, Durbin-Johnson, Blythe, Javidan, Yashar, Klineberg, Eric Otto
• Format: Article
• Language: English
• Subjects: Case Series; Child; Humans; Medicine; Medicine & Public Health; Orthopedics; Povidone-Iodine; Powders; Retrospective Studies; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control; Therapeutic Irrigation; Vancomycin
• ISSN: 2212-134X; 2212-1358
• DOI: 10.1007/s43390-021-00333-3

Background Surgical site infection is a morbid, devastating complication after spinal procedures. Studies have investigated the effect of wound lavage with 3.5% Povidone-iodine solution or the use of intrawound Vancomycin powder. We examined the effect of Povidone-iodine irrigation, intrawound Vancomycin powder, or a combination of both agents in a tertiary care Pediatric Hospital. Methods We queried our health system database for patients undergoing spinal surgery over an eight-year span between January 2008 and June 2016 and identified patient cohorts who received no intervention, intrawound Vancomycin alone, Povidone-iodine irrigation alone, or a combination of both agents. Infection rates were determined. The effect of treatment on outcome was analyzed using a logistic regression model. Results 475 patients were identified who met study inclusion criteria. 88 non-neuromuscular patients received no intra-operative agent. The surgical site infection (SSI) rate in this group of patients was 10%. For the 194 non-neuromuscular scoliosis patients who received Povidone-iodine and Vancomycin powder, the infection rate was reduced to 0.7%. The SSI rate in the 180 non-neuromuscular patients who were treated with Vancomycin powder alone was 1.4%. 13 patients were treated with Povidone-iodine lavage only, with a small sample size precluding statistical comparison. Infection rate in the 132 neuromuscular disease patients decreased from 14 to 7% overall during this time span: while the odds ratio of infection was reduced in all neuromuscular treatment groups receiving intra-operative measures, statistical significance was not reached in any neuromuscular group studied. Conclusions A protocol using combined 3.5% weight/volume Povidone-iodine and Vancomycin powder was associated with the lowest infection rate in our non-neuromuscular patient population and should be considered as a low cost intervention in pediatric patients undergoing spinal deformity procedures. Level of evidence Level II.