Effect of intrawound vancomycin application in spinal surgery on the incidence of surgical site infection: a meta-analysis

Figures & data

Figure 1 Selection of papers for this research. A total of 27 studies were included in the final analysis.

Table 1 Demographic characteristics of included studies

	Experimental/control	Average age (years)	Study design	Evidence	Quality	Surgery type	Fixation	Dose (g)	Applied in all layers	Site of infection	Follow-up (months)
Caroom et al^Citation31	40/72	59.8/56.4	Retrospective	2	7	Cervical	100	1	Yes	Deep, superficial	6
Cannon et al^Citation35	68/27	6.3/5.4	Retrospective	2	6	NA	0	1	Yes	Deep, superficial	3
Hey et al^Citation10	117/272	45/48	Retrospective	3	6	NA	100	1	Yes	Deep, superficial	3
Devin et al^Citation11	966/1,090	60.5/59.5	Retrospective	2	7	NA	79.2	1	No	Deep, superficial	NA
Emohare et al^Citation12	96/207	53.7/58.2	Retrospective	3	6	NA	NA	1	No	Deep, superficial	NA
Garg et al^Citation36	228/310	13.8/14	Retrospective	3	7	Deformity	100	0.5–2	Yes	Deep	3
Godil et al^Citation13	56/54	43/45	Retrospective	3	6	Fracture	100	1	No	Deep, superficial	3
Haimoto et al^Citation14	247/268	58.4/54.4	Retrospective	3	7	NA	100	1	No	Deep, superficial	NA
Heller et al^Citation15	342/341	55.3/49.1	Retrospective	3	7	NA	100	0.5–1	Yes	Deep	3
Hida et al^Citation16	81/93	48.4/50.3	Retrospective	3	6	NA	56.3	0.5–1	Yes	Deep	20
Hill et al^Citation17	150/150	54.1/58.3	Retrospective	3	6	NA	NA	1–2	Yes	Deep, superficial	1
Kim et al^Citation19	34/40	57.9/60.0	Retrospective	3	5	NA	100	1	No	Deep, superficial	NA
Martin et al^Citation20	115/174	62.3/57.6	Retrospective	3	6	Cervical	100	2	No	Deep	NA
Martin et al^Citation21	156/150	63.4/62.7	Retrospective	2	7	Deformity	100	2	No	Deep	NA
O’Neil et al^Citation22	56/54	43/45	Retrospective	3	6	Fracture	100	1	No	Deep, superficial	NA
Pahys et al^Citation23	195/806	59/53.6	Retrospective	3	7	Cervical	100	0.5	Yes	Deep, superficial	3
Strom et al^Citation24	156/97	64/64	Retrospective	2	7	Lumbar	100	1	Yes	Deep, superficial	12
Strom et al^Citation24	79/92	60/60	Retrospective	2	7	Cervical	100	1	Yes	Deep, superficial	12
Sweet et al^Citation26	911/821	56/53	Retrospective	3	7	Lumbar, thoracic	100	No	否	Deep	30
Theologis et al^Citation27	151/64	60/62.4	Retrospective	3	6	Deformity	100	2	Yes	Deep, superficial	3–35
Thompson et al^Citation28	104/87	7.1±2.8	Retrospective	3	6	Deformity	100	1	Yes	Deep	NA
Tomov et al^Citation29	1,173/1,252	57.4	Retrospective	3	6	NA	NA	1	Yes	Deep, superficial	NA
Tubaki et al^Citation30	433/474	44.5/46.6	RCT	2	7	NA	66.8	1	No	Deep, superficial	3
Mirzashahi et al^Citation32	193/187	NA	RCT	2	6	NA	100	1–2	No	Deep	15
Horii et al^Citation18	694/2,165	68.5/65	Retrospective	3	6	NA	100	1–2	Yes	Deep, superficial	12
Feng and Yang^Citation34	297/267	60.1/57.5	Retrospective	3	5	NA	62.6	1	No	Deep, superficial	NA
Li 2016^Citation33	206/363	51.5/53.7	Retrospective	3	6	Lumbar	100	1	Yes	Deep, superficial	12

Abbreviations: NA, not available; RCT, randomized controlled trial.

Figure 2 Overall surgical site infection incidence was significantly low when vancomycin was applied locally after surgery (P<0.01).

Figure 3 Meta-analysis of randomized controlled trials (RCTs) and retrospective studies.

Figure 4 Local application of vancomycin reduced surgical site infections after surgery irrespective of whether internal fixation was used.

Figure 5 Local application of vancomycin reduced surgical site infections after surgery in both spinal deformity surgeries and nondeformity surgeries.

Figure 6 Local application of vancomycin significantly reduced surgical site infection incidence in patients who received cervical, thoracic, or lumbar surgical treatment.

Figure 7 Subgroup analysis of incidence of deep (upper) and superficial (lower) tissue infections after spinal surgeries.

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