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Purpose <p>Oncologic spine surgery carries a high risk of surgical site infection (SSI). We assessed the impact of intraoperative topical vancomycin on SSI rates and its economic impact in patients undergoing surgery for spinal metastases.</p> Methods <p>We retrospectively reviewed 97 patients treated surgically for spinal metastases between 2022 and 2025. Local vancomycin powder was applied to the wound in 32 patients (32%). SSI rates, clinical outcomes, and costs were compared between groups. An exploratory LASSO-penalized logistic regression model was developed to identify predictors of SSI.</p> Results <p>SSI occurred in 8 patients (8.2%; five deep). No infections were observed in the vancomycin group (0/32), whereas 8 of 65 patients (12.3%) without vancomycin developed SSI (<i>p</i> = 0.0496), corresponding to an absolute risk reduction of 12.3% points (NNT = 9). Due to a zero-event cell, the odds ratio was estimated using a continuity correction (Haldane–Anscombe; OR = 0.10, 95% CI 0.006–1.86); the relative risk was RR = 0.12 (95% CI 0.007–1.98). Patients with SSI had longer hospital stays (19.1 ± 8.6 vs. 8.6 ± 5.6 days; <i>p</i> &lt; 0.001). The estimated prophylaxis cost to prevent one SSI was 19–59 EUR versus an average SSI management cost of ~ 3,500 EUR, suggesting a favorable cost profile. In the LASSO model, vancomycin was selected as a protective feature, although discrimination was modest.</p> Conclusions <p>Topical vancomycin appears to reduce SSI risk and is a safe, inexpensive prophylactic option in metastatic spine surgery, with a likely cost-saving effect under local cost assumptions.</p>

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Prophylactic use of topical vancomycin reduces the incidence of postoperative wound infection in surgery for spinal metastases

  • 期刊论文

  • 发表日期：

    2026年3月25日

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  • Kamil Krystkiewicz,
  • Aleksander Kowal,
  • Magdalena Krystkiewicz-Orzechowska,
  • Łukasz Kuncman,
  • Marcin Tosik

摘要

Purpose

Oncologic spine surgery carries a high risk of surgical site infection (SSI). We assessed the impact of intraoperative topical vancomycin on SSI rates and its economic impact in patients undergoing surgery for spinal metastases.

Methods

We retrospectively reviewed 97 patients treated surgically for spinal metastases between 2022 and 2025. Local vancomycin powder was applied to the wound in 32 patients (32%). SSI rates, clinical outcomes, and costs were compared between groups. An exploratory LASSO-penalized logistic regression model was developed to identify predictors of SSI.

Results

SSI occurred in 8 patients (8.2%; five deep). No infections were observed in the vancomycin group (0/32), whereas 8 of 65 patients (12.3%) without vancomycin developed SSI (p = 0.0496), corresponding to an absolute risk reduction of 12.3% points (NNT = 9). Due to a zero-event cell, the odds ratio was estimated using a continuity correction (Haldane–Anscombe; OR = 0.10, 95% CI 0.006–1.86); the relative risk was RR = 0.12 (95% CI 0.007–1.98). Patients with SSI had longer hospital stays (19.1 ± 8.6 vs. 8.6 ± 5.6 days; p < 0.001). The estimated prophylaxis cost to prevent one SSI was 19–59 EUR versus an average SSI management cost of ~ 3,500 EUR, suggesting a favorable cost profile. In the LASSO model, vancomycin was selected as a protective feature, although discrimination was modest.

Conclusions

Topical vancomycin appears to reduce SSI risk and is a safe, inexpensive prophylactic option in metastatic spine surgery, with a likely cost-saving effect under local cost assumptions.