Topical
vancomycin has been demonstrated to be safe and effective for reducing
surgical site infections (SSIs) following spine surgery in both adults and children, however, there are no studies of its efficacy in reducing SSIs in craniofacial surgery. The SSIs are one of the most common complications following craniofacial surgery. The complexity of craniofacial procedures, use of grafts and implants, long operative durations and larger
surgical wounds all contribute to the heightened risk of SSIs in pediatric craniofacial cases. A retrospective review of all open and endoscopic pediatric craniofacial procedures performed between May 2014 and December 2017 at a single children's hospital was conducted to examine SSI rates between patients receiving topical
vancomycin and a historical control group. The treatment group received topical
vancomycin irrigation before
wound closure. An ad-hoc cost analysis was performed to determine the cost-savings associated with topical
vancomycin use. A total of 132 craniofacial procedures were performed during the study period, with 50 cases in the control group and 82 cases in the
vancomycin group. Overall, SSI rate was 3.03%. Use of topical
vancomycin irrigation led to a significant reduction in SSIs (4/50 SSI or 8.0% in control group vs 0/82 or 0% in
vancomycin group, Pā=ā0.04). No adverse events were observed with topical
vancomycin use. The potential cost-savings associated with the use of topical
vancomycin as SSI prophylaxis in this study was $102,152. Addition of topical
vancomycin irrigation as routine surgical
infection prophylaxis can be an effective and low-cost method for reducing SSI in pediatric craniofacial surgery.