Betadine wash and usage of absorbable vancomycin tobramycin beads reduces infection in Adult scoliosispatients undergoing anterior posterior Thoraco-lumbar spine fusions to pelvis

Betadine wash and usage of absorbable vancomycin tobramycin beads reduces infection in Adult scoliosispatients undergoing anterior posterior Thoraco-lumbar spine fusions to pelvis

AUTHORS/INSTITUTIONS: A. Kumar, M. Kumar, , colorado spine and scoliosis, littleton, CO;www.cobackandspine.com

ABSTRACT BODY:
Summary: In this prospective consecutive series of Anterior posterior thoraco-lumbar spine fusions for adult scoliosis above 30 degrees (30-104 degrees)we had 1 infection in 157 patients(higher risk) fused to pelvis after a betadine wash and installation of absorbable antibiotic beads impregnated with 2 grams of Vancomycin and 2.8 grams of tobramycin. We had 4 infections in 112 patients undergoing thoraco-lumbar spine fusions not including the pelvis after a wash out with saline .All infections were due to staphylococcus Aureus and there were no late infections in this series.

Introduction: The incidence of infection reported in the literature in adult scoliosis fusions varies from 4.5%-11%.The risk factors include obesity, revision surgery, length of surgery, blood loss/transfusions, fusions to pelvis.We have had only 3 infections 1999-2010 in our non scoliosis patients undergoing surgery and hence we did not use historical controls . This study was undertaken to see if we could reduce the risk of infection in our highest risk patient population undergoing Anterior/posterior spine fusion for adult Kyphoscoliosis and compare our results with that reported in the literature. We reduced the incidence of infection in our series by washing the wound prior to closure with betadine and usage of absorbable antibiotic beads.

Methods: This is a single surgeon prospective consecutive series of adult kypho scoliosis patients(2005-2010) who had thoraco lumbar fusion to pelvis. These higher risk patients were randomised to have a betadine wash with installation of absorbable antibiotic beads. The adult scoliosis that did not need fusion to pelvis were washed out with normal saline.The implants trays were opened just prior to implantation. All surgeries were performed by the same
surgeon , assistant and anesthesiologist.All patients had TPN after the anterior approach until they were discharged from hospital. Long term follow up was performed for late infections.

Results: We had 1 infection (1/157)in the series fused to the pelvis. He had no prior spine surgery.
134 of 157 patients (fused to pelvis) had prior posterior spine surgeries(1-7surgeries)Blood loss ranged 600-5100 cc.  There were 12 ASA 2 patients, 90 ASA 3patients and 55 ASA 4 patients.
74 patients had a upper thoracic to pelvis fusion and 83 had a low thoracic to pelvis fusion.
113/157 patients were over 60 yrs .We had 4 of the 112 adult scoliosis (not fused to pelvis) patients infected after similar saline wash out.There were 9 ASA 2, 66 ASA 3 and 37ASA 4 patients with blood loss 700-3000 cc .61/112 patients were over 60 years age.

Conclusion: Despite lengthy anterior posterior spine fusions in an elderly population with multiple comorbidities we can reduce infections after a betadine wash and installation of antibiotic beads and meticulous surgical technique.