Clinical Outcomes of Vancomycin Powder for Surgical Site Prophylaxis in Orthopedic Surgeries: A Comparative Study.

Background: Surgical site infections (SSIs) remain a significant challenge in orthopedic surgery, despite existing methods for lowering SSI rates, contributing to increased morbidity, mortality, and healthcare costs. The search for more effective prophylaxis strategies is a major area of research to reduce postoperative morbidity and mortality. Topical application of vancomycin powder (VP) has been suggested as an adjunctive measure for reducing SSIs.

Objective: To evaluate the effectiveness of intraoperative topical VP in preventing SSIs in orthopedic surgeries.

Methods:  A comparative hospital-based observational study was conducted at Future Hospital, Khartoum, from September 2021 to October 2022. A total of 300 patients undergoing orthopedic surgery were enrolled and divided into two equal groups: a VP group (n=150) receiving intra-wound VP and a control group (n=150) without VP. Data on postoperative SSI and other variables were collected from hospital records and analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2018; IBM Corp., Armonk, New York, United States).

Results: A total of 300 patients were included. The mean patient age was 42.4±19.5 years, and 205 patients (68.3%) were male. There were no significant differences between observed cases and control groups in age, gender, occupation, diagnosis, and type of operations. Fractures were the most common indication for surgery (158 patients, 52.7%), and decompression with fixation was the most frequent procedure (143 patients, 47.7%). Patient age was significantly associated with SSIs (p=0.009), with older patients showing higher rates. The SSI rate was significantly lower in the topical VP group (four patients, 2.7%) compared to the control group (11 patients, 7.3%) (P=0.042). No vancomycin-related adverse reactions were observed.

Conclusion:  The intraoperative application of VP significantly reduced the incidence of SSIs in orthopedic surgeries. Routine use of VP should be considered, especially in high-risk patients.