ABSTRACT
The search for literature sources in domestic and foreign databases showed the absence of works devoted to the study of risk factors for venous thromboembolic events (VTE) in patients of the older age group with diabetes mellitus who are planned to undergo surgical interventions on the spine, which was the impetus for this study. The aim of the study was to study the risk factors for VTE in elderly and senile patients with diabetes mellitus who are scheduled for spinal surgery. A single-center retrospective study included 119 elderly and senile patients (64 men, 55 women, mean age 74,2±6,5 years) who underwent various surgical interventions on the spinal column. According to the binary logistic regression model, the following parameters are statistically significantly associated with the development of VTEC in the studied group of respondents: age of patients over 75 years (p=0,048), HbA1C levels over 7,5% (p=0,007) and D-dimer over 0,5 mg /l FEU (p=0,034), as well as high risk (5 points or more) of VTE according to Caprini scale (p=0,012). In order to reduce the incidence of VTE in elderly and senile patients with diabetes mellitus who are planned to perform surgical interventions on the spine, it is necessary to verify the above clinical and laboratory parameters in the early stages of hospitalization.
Subject(s)
Diabetes Mellitus , Venous Thromboembolism , Male , Humans , Female , Aged , Venous Thromboembolism/diagnosis , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiology , Retrospective Studies , Risk Factors , Spine/surgery , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/etiologyABSTRACT
OBJECTIVE: To perform a meta-analysis of studies examining the effectiveness of the local application of vancomycin powder for the prophylaxis of surgical site infections (SSIs) in spine surgery. MATERIAL AND METHODS: Retrospective cohort studies and prospective randomized clinical trials were searched for in the Pubmed, EMBASE, Cochrane Library and eLibrary databases published from 2008 to December 2018. For the resulting variables, the odds ratio and 95% confidence interval were calculated using random and fixed effects models. Estimation of the degree of heterogeneity is estimated using the coefficient I2. Statistically significant differences were considered differences p<0.05. RESULTS: The meta-analysis included 28 clinical studies that included the results of the local application of vancomycin powder in 17,469 patients after performing various spinal surgical interventions. Two publications had a prospective, randomized, controlled study design. Topical application of vancomycin powder reduces the incidence of SSIs after spine surgery (p<0.0001). The use of vancomycin powder reduces the incidence of SSIs in patients operated on with stabilizing implants (p=0.004). On the other hand, the topical application of vancomycin powder did not affect the prevalence of SSIs in respondents who were operated on without the use of stabilizing implants (p=0.12) or due to deformities of the spine (p=0.06). CONCLUSION: Topical application of vancomycin powder is highly effective in preventing the development of SSIs in patients after spinal surgical interventions.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Spine/surgery , Surgical Wound Infection/prevention & control , Vancomycin/administration & dosage , Administration, Topical , Antibiotic Prophylaxis , Humans , Powders/administration & dosage , Randomized Controlled Trials as Topic , Spinal Diseases/surgery , Surgical Wound Infection/etiologyABSTRACT
AIM: To evaluate an efficacy of local administration of vancomycin powder in posterior lumbar fusion surgery for prevention of local infection. MATERIAL AND METHODS: The study included 214 patients. All patients were divided into 2 groups: I group (control) and II (experimental). Patients of the first group underwent conventional antibiotic prophylaxis of wound infections, in group II traditional antibiotic prophylaxis was supplemented by local administration of vancomycin powder 1 g prior to wound closure. RESULTS: There were 12 cases of wound infection in group I and 5 cases in group II. There were significant differences in overall incidence of wound infection and wound infections caused by S. aureus (p=0.035; p=0.044, respectively). Significant risk factors of local infection were determined in group II: obesity, diabetes mellitus, arterial hypertension, coronary artery disease, length of hospital-stay and previous lumbosacral spinal surgery. Multivariate analysis revealed following risk factors of wound infection: diabetes mellitus, arterial hypertension, coronary artery disease, the number of involved spinal segments and previous lumbosacral spinal surgery. CONCLUSION: Local application of vancomycin powder in posterior lumbar fusion surgery significantly reduces the incidence of wound infection.
