Impact of intraoperative administration of local vancomycin on inguinal wound complications

Objective: Local vancomycin treatment has been shown to decrease sternal wound complication rates. Whether a similar effect can be achieved at other surgical sites is unknown. This study investigates the effect of local vancomycin on inguinal wound complication rates after vascular procedures. Methods: Retrospective analysis was performed on 454 patients who underwent open aortofemoral or infrainguinal vascular procedures between 2006 and 2011. Patients received preoperative systemic antibiotics either alone (group A) or in conjunction with intraoperative wound application of vancomycin powder and irrigation (group B). Inguinal wound infection and dehiscence over a 30-day period were recorded. Fisher exact test and multivariate regression analyses were performed. Results: There were 211 patients in group A and 243 patients in group B. Both groups had similar demographics and operative characteristics. There was a small but statistically significant decrease in the 30-day incidence of overall wound infections (25.1% vs 17.2%; P=.049) for group B patients. This was primarily due to a decreased rate in superficial infections (18.9% vs 11.5%; P=.033). No significant difference in the incidence of deep wound infections (6.1% vs 5.7%; P=.692) or overall dehiscence rates (22.2% vs 17.7%; P=.239) was detected. On multivariate analysis, history of chronic obstructive pulmonary disease and increased body mass index significantly increased risk of both infection and dehiscence. Medically optimized coronary artery disease was associated with less risk for dehiscence. Conclusions: Addition of intraoperative local vancomycin did not improve the rates of inguinal wound dehiscence or deep infections but had a positive impact on superficial wound infections. (J Vasc Surg 2013;57:1079-83.)