Our next presenter is Dr. Arka Malala, who is going to be talking about topical vancomycin reduces hospital costs associated with surgical site infections and craniotomy. Good afternoon everyone. My name is Arka Malala. I'll be a doctor in two weeks, not quite yet. Today I'm going to talk about topical vancomycin. In a previous study we've shown that it reduces surgical site infections after craniotomy. Now we're going to discuss some of the financial implications of that and how significant cost savings can be realized by using this method. We have no conflicts of interest to report. Just to give some background, approximately 1.7 million hospital-acquired infections per year. That translates to about 99,000 deaths per year. There are significant costs associated with these. In this study and other studies it has been shown that greater than $20,000 per infection when you have to include costs for readmission, washout, etc. This totals almost $3 billion in costs per year. In a previous study, in a retrospective series, we showed that it was 81% reduction in risk using topical vancomycin. In this current cohort we showed that the percentage is reduced from 6% infection rate to about 0.49%. Now we're going to calculate the financial savings realized through this method. Basically we had 355 patients from 15 different surgeons and 3 hospitals in one system. They were in two cohorts, 205 in the vancomycin-treated group and 150 without vancomycin treatment. We used a mixed-effects logistic model that took these falling factors into account. Demographics, past medical history, other comorbidities. Basically vancomycin was applied in the subgaleal space. What we did for this study is collect the costs from the vancomycin directly from patient data and compare the two. As you can see here, demographically and in terms of past medical history, the patients were essentially equivalent. But there was a significant reduction in the number of SSIs. There were 9 in the control group and only 1 in the vancomycin-treated group. We discussed this previously, but basically the relative risk of SSI was similar to what we found in our first previous study, with a relative risk of 0.081. Just to make that more realistic or more understandable, you would probably need to treat 18 patients with topical vancomycin to prevent one infection. Cost-wise, the direct infection costs in the vancomycin group were $13,000 just for that one patient, compared to $206,000 in the control group. Even the mean direct costs per patient were actually lower in the vancomycin group. That could be for a variety of reasons. One is that the patient treated with vancomycin presented an 85 days post-op and could have been delayed inoculation. The length of stay for that patient was actually much shorter than the majority of the patients in the control group. Topical vancomycin is very cheap. $12 is actually a fairly conservative estimate. Some estimates are as low as $2. Over $1.3 million in cost savings can be realized if you extrapolate over 1,000 patients. Significant cost savings can be realized through routine use of topical vancomycin. This is Class IIa evidence supporting the role of topical vancomycin. I know there are further studies going on now that are randomization, but I think based off this data at our institution, we're using topical vancomycin routinely now. That's it. Thank you. That was fantastic. We actually do have some time for a question if there's any from the audience. You got through that so fast. Please come to the microphone and ask our presenter. I just wanted to ask you, what was the intravenous antibiotic used? What was the dose, and were they re-dosed at four hours? What was the intravenous protocol in these patients? I'm not fully familiar with the information off the top of my head. I do believe it was Caflex as a standard prophylaxis. Khalil, did you want to comment on that? Dr. Rosenau, I had a question. Quick question. In the spine literature and in our experience when we've used topical vancomycin in spine wound closure, we have seen an increasing incidence of sterile wound seroma. Have you seen that in the craniotomy set? As far as I know, I don't believe we have. There wasn't significant fluid accumulation. In the first series, they looked at a drain output as well, and there wasn't any change, I believe. Give it time. Thank you very much. Congratulations, by the way. Okay, so congratulations on becoming a physician in two weeks.

Dr. Arka Malala

topical vancomycin

surgical site infections

hospital costs

craniotomy