Prospective RCT of 907 patients undergoing open spine surgery comparing standard IV cefuroxime prophylaxis alone versus IV cefuroxime plus 1 g intrawound vancomycin powder. Primary outcome was postoperative surgical site infection rate. This is among the first randomized trials to test a practice widely adopted from retrospective data.
When your institution already maintains low baseline spine infection rates with standard systemic prophylaxis, this RCT shows that adding intrawound vancomycin powder provides no measurable benefit — reserve enthusiasm for this adjunct for genuinely high-risk cases (trauma, obesity, revision surgery) where retrospective data suggest a larger effect size to overcome.
Prospective RCT of 907 patients undergoing open spine surgery comparing standard IV cefuroxime prophylaxis alone versus IV cefuroxime plus 1 g intrawound vancomycin powder. Primary outcome was postoperative surgical site infection rate. This is among the first randomized trials to test a practice widely adopted from retrospective data.
When your institution already maintains low baseline spine infection rates with standard systemic prophylaxis, this RCT shows that adding intrawound vancomycin powder provides no measurable benefit — reserve enthusiasm for this adjunct for genuinely high-risk cases (trauma, obesity, revision surgery) where retrospective data suggest a larger effect size to overcome.