The cost effectiveness of vancomycin for preventing infections after shoulder arthroplasty: a break-even analysis

Hatch, Mark; Daniels, Stephen D.; Glerum, Kimberly M.; Higgins, Laurence D.

doi:10.1016/j.jse.2016.07.071

Cited by 80 publications

(72 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Adjunctive use of vancomycin powder also has been shown to reduce morbidity and lead to significant health care cost savings. 9,14,32 However, despite the adjunctive use of vancomycin powder, postoperative SSI after adult deformity surgery remains a serious concern.…”

mentioning

confidence: 99%

Prophylactic use of intraoperative vancomycin powder and postoperative infection: an analysis of microbiological patterns in 1200 consecutive surgical cases

Adogwa

Elsamadicy

Sergesketter

et al. 2017

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

OBJECTIVEWound infections following spinal surgery for deformity place a high toll on patients, providers, and the health care system. The prophylactic application of intraoperative vancomycin powder has been shown to lower the infection risk after thoracolumbar decompression and fusion for deformity correction. The purpose of this study was to assess the microbiological patterns of postoperative surgical site infections (SSIs) after prophylactic use of vancomycin powder in adult patients undergoing spinal deformity surgery.METHODSAll cases involving adult patients who underwent spinal deformity reconstruction at Duke University Medical Center between 2011 and 2013 with a minimum of 3 months of clinical follow-up were retrospectively reviewed. In all cases included in the study, crystalline vancomycin powder was applied to the surgical bed for infection prophylaxis. Baseline characteristics, operative details, rates of wound infection, and microbiological data for each case were gathered by direct medical record review.RESULTSA total of 1200 consecutive spine operations were performed for deformity between 2011 and 2013. Review of the associated records demonstrated 34 cases of SSI, yielding an SSI rate of 2.83%. The patients’ mean age (± SD) was 62.08 ± 14.76 years. The patients’ mean body mass index was 30.86 ± 7.15 kg/m2, and 29.41% had a history of diabetes. The average dose of vancomycin powder was 1.41 ± 2.77 g (range 1–7 g). Subfascial drains were placed in 88% of patients. All SSIs occurred within 30 days of surgery, with deep wound infections accounting for 50%. In 74% of the SSIs cultures were positive, with about half the organisms being gram negative, such as Citrobacter freundii, Proteus mirabilis, Morganella morgani, and Pseudomonas aeruginosa. There were no adverse clinical outcomes related to the local application of vancomycin.CONCLUSIONSOur study suggests that in the setting of prophylactic vancomycin powder use, the preponderance of SSIs are caused by gram-negative organisms or are polymicrobial. Further randomized control trials of prophylactic adjunctive measures are warranted to help guide the choice of empirical antibiotic therapy while awaiting culture data.

show abstract

mentioning

confidence: 99%

Prophylactic use of intraoperative vancomycin powder and postoperative infection: an analysis of microbiological patterns in 1200 consecutive surgical cases

Adogwa

Elsamadicy

Sergesketter

et al. 2017

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

show abstract

“…Where: S total ¼ total annual surgeries; C t ¼ total cost of treating an infection; C d ¼ cost of drug; IR i ¼ initial infection rate; IR f ¼ breakeven infection rate. Adapted from Hatch et al 18 analyses, the costs of revision following infection after both procedures were held constant. These calculations demonstrated that even at initial infection rates as high as 10%, the cost-effectiveness of vancomycin powder in both procedures remained unchanged with an ARR of 0.015% for lumbar laminectomy alone and 0.0034% for laminectomy with fusion ( Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Within the literature, the cost of vancomycin powder was found to range from $2.50 to $44. 13,[16][17][18]22,23…”

Section: Methodsmentioning

confidence: 99%

The Cost-Effectiveness of Vancomycin Powder in Lumbar Laminectomy

Kerbel

Kirchner

Sunkerneni

et al. 2019

Global Spine Journal

View full text Add to dashboard Cite

Study Design: Break-even cost analysis. Objective: The goal of this study is to examine the cost-effectiveness of vancomycin powder for preventing infection following lumbar laminectomy. Methods: The product cost of vancomycin powder was obtained from our institution’s purchasing records. Infection rates and revision costs for lumbar laminectomy and lumbar laminectomy with fusion were obtained from the literature. A break-even analysis was then performed to determine the absolute risk reduction (ARR) in infection rate to make prophylactic application of vancomycin powder cost-effective. Analysis of lumbar laminectomy with fusion was performed for comparison. Results: Costing $3.06 per gram at our institution, vancomycin powder was determined to be cost-effective in lumbar laminectomy if the infection rate of 4.2% decreased by an ARR of 0.015%. Laminectomy with fusion was also determined to be cost-effective at the same cost of vancomycin powder if the infection rate of 8.5% decreased by an ARR of 0.0034%. The current highest cost reported in the literature, $44.00 per gram of vancomycin powder, remained cost-effective with ARRs of 0.21% and 0.048% for laminectomy and laminectomy with fusion, respectively. Varying the baseline infection rate did not influence the ARR for either procedure when the analysis was performed using the product cost of vancomycin at our institution. Conclusions: This break-even analysis demonstrates that prophylactic vancomycin powder can be highly cost-effective for lumbar laminectomy. At our institution, vancomycin powder is economically justified if it prevents at least one infection out of 6700 lumbar laminectomy surgeries.

show abstract

“…Medicare databases were utilized to confirm that in 2016. Regarding infection prevention, a cost-effectiveness study using various modeling assumptions found that vancomycin powder could be cost-effective for preventing infection after shoulder arthroplasty, even if the absolute risk reduction was low 10 . It is known that P. acnes infections are difficult to diagnose, as they may not be associated with inflammation.…”

Section: Shoulder and Elbowmentioning

confidence: 99%

“…Knee Surg Sports Traumatol Arthrosc. 2016 Oct;24 (10):3147-54. Epub 2015 May 28. This retrospective case series on arthrotomy versus arthroscopy for native knee septic arthritis found arthroscopy to be preferred.…”

Section: Evidence-based Articles Related To Musculoskeletal Infectionmentioning

confidence: 99%

What’s New in Musculoskeletal Infection: Update Across Orthopaedic Subspecialties

Chen

Nana²,

Nelson³

et al. 2017

The Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

show abstract

The cost effectiveness of vancomycin for preventing infections after shoulder arthroplasty: a break-even analysis

Cited by 80 publications

References 29 publications

Prophylactic use of intraoperative vancomycin powder and postoperative infection: an analysis of microbiological patterns in 1200 consecutive surgical cases

Prophylactic use of intraoperative vancomycin powder and postoperative infection: an analysis of microbiological patterns in 1200 consecutive surgical cases

The Cost-Effectiveness of Vancomycin Powder in Lumbar Laminectomy

What’s New in Musculoskeletal Infection: Update Across Orthopaedic Subspecialties

Contact Info

Product

Resources

About