Efficacy and Safety of Topical Vancomycin for the Prevention of Surgical Site Infections in Spinal Surgery: A Meta-Analysis of Randomized Controlled Trials.

Abstract

This meta-analysis aimed to critically examine the effectiveness and safety of intraoperative topical vancomycin in preventing surgical site infections (SSIs) following spinal surgery. A systematic literature search was performed across CNKI, Medline, Embase, PubMed, the Cochrane Library, Web of Science, and Clinical Trials Registry from database inception to June 2025. Only randomized controlled trials (RCTs) evaluating prophylactic intraoperative topical vancomycin in spinal operations were included. A total of 12 RCTs involving 4366 patients were included. Pooled results demonstrated that the topical vancomycin group had a significantly lower incidence of overall SSIs compared to controls [OR=0.60, 95% CI: 0.43-0.83, P=0.002], as well as deep SSIs [OR=0.66, 95% CI: 0.44-0.98, P=0.04]. Subgroup analyses: (1) Dosage-based subgroup: Application of ≤1g vancomycin significantly reduced overall SSIs (P<0.0001), deep SSIs (P=0.004), and superficial SSIs (P=0.005). (2) Surgical type subgroup: In patients undergoing instrumented spinal procedures, topical vancomycin use resulted in a marked decrease in SSI risk (P=0.002). Topical intraoperative application of vancomycin appears to be a safe and effective strategy for reducing the incidence of SSIs in spinal surgeries. Subgroup analyses suggest that doses ≤1g are particularly effective in reducing overall, deep, and superficial SSIs. Furthermore, the preventive effect is more pronounced in instrumented surgeries compared to noninstrumented procedures. However, due to the relatively limited pool of RCTs currently available, further high-quality, large-scale, and multicenter trials are essential to substantiate these conclusions.