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Brook I Martin, Sohail K Mirza, Nicholas Spina...
https://pubmed.ncbi.nlm.nih.gov/30074971/Actively Recruiting
Led by Rhode Island Hospital · Updated on 2024-11-20
200
Participants Needed
1
Research Sites
N/A
Total Duration
Researchers are investigating the use of different irrigation methods during spinal instrumentation surgery, which is commonly performed to treat traumatic, oncologic, and degenerative spinal conditions. The study evaluates whether using Irrisept, a chlorhexidine gluconate solution, can reduce post-operative complications such as surgical site infections, seromas, and wound breakdown compared to the standard vancomycin-saline irrigation, which sometimes increases the risk of seroma formation. This trial is a prospective, randomized controlled study conducted on adults undergoing posterior spinal instrumentation for various indications. Participants will be randomly assigned to receive either Irrisept irrigation or vancomycin-saline irrigation with or without topical vancomycin powder during their spinal surgery. Irrisept is administered through a low-pressure lavage system and has been effective as a bactericidal agent in other orthopedic procedures. The standard care group receives vancomycin-saline irrigation, which targets gram-positive bacteria but may not be as effective against gram-negative organisms and may increase seroma risk. During the study, patients will be monitored for surgical site infections up to 90 days after surgery, along with other complications like wound dehiscence, hospital readmission, and atypical infections for up to 12 months. Researchers will also track length of hospital stay, mortality, drain removal time, and overall cost of care. The trial aims to gather comprehensive data on post-operative outcomes and safety, with follow-up visits and evaluations throughout one year after surgery.
CONDITIONS
Irrisept Solution for Instrumented Spine Surgery
A
Alexander Chernysh
O
Owen Leary
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Rhode Island Hospital
Lead Sponsor
This table compares participation in this trial with other options available for this condition. The information is drawn from published research and the trial’s study details and is provided for educational purposes only.
| Factors | Irrisept Irrigation | Vancomycin-Saline Irrigation |
|---|---|---|
| What it is | Sterile irrigation using Irrisept (chlorhexidine gluconate solution) delivered into the surgical wound during closure in instrumented spinal procedures. | Irrigation of the surgical wound using vancomycin-saline solution, with or without topical vancomycin, given at wound closure during instrumented spine surgery. |
| Role in trial | Investigational intervention designed to reduce surgical site infection in eligible spine surgery patients. | Active comparator arm reflecting common current-care practice to prevent post-operative wound infection during spine surgery. |
| Primary use | Used intraoperatively to reduce the risk of surgical site infections following instrumented spinal operations. | Used intraoperatively to reduce the risk of post-surgical infection in spinal procedures with instrumentation. |
| How it is given or performed | Irrigation with sterile chlorhexidine gluconate (Irrisept solution) is performed in the wound during closure at the end of the surgery. | Sterile vancomycin-saline solution, with or without added topical vancomycin, is used to irrigate the surgical site just prior to layer-by-layer or locoregional flap closure. |
| Evidence status | Results regarding the impact of intraoperative Irrisept irrigation on surgical site infection rates in instrumented spine surgery are not yet available from randomized controlled trials. A meta-analysis found insufficient high-quality data for chlorhexidine-specific irrigation in this population. | Intrawound vancomycin powder and irrigation are frequently used to lower infection risk, but data regarding their efficacy in complex instrumented spine surgery are mixed. Recent systematic reviews and studies note variable reductions in SSI rates and call for higher-quality randomized evidence. |
| Important limitations | The effect of chlorhexidine irrigation in spine surgery is not established for SSI prevention; prior studies are limited by small sample sizes, or are conducted in other surgical fields rather than complex spinal instrumentation. | Despite widespread use for SSI prevention, the benefit of vancomycin-saline irrigation is debated, and well-powered trials specific to high-risk or instrumented spine cases are limited. |
Disclaimer: This comparison is created with the help of artificial intelligence(AI) and may contain errors or missing information. It is not medical advice and does not mean one option is better or safer than another. Clinical trials are still being studied, and joining a trial is your choice. Please consult your healthcare professional before making any decisions.
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Duration - 2 to 4 weeks
Participants are screened for eligibility to participate in the trial.
1 visit (in-person)
Duration - Surgery day plus initial hospitalization period
Participants undergo spinal instrumentation surgery during which they receive intra-operative irrigation with either Irrisept solution or vancomycin-saline irrigation, followed by immediate post-operative care.
1 surgical visit and hospital stay
Duration - Up to 12 months post-operatively
Participants are monitored for post-operative complications such as surgical site infection and wound healing, with assessments continuing for up to 12 months after surgery.
Periodic follow-up visits over 12 months
Study Type
INTERVENTIONAL
Masking
SINGLE
Allocation
RANDOMIZED
Model
PARALLEL
Primary Purpose
PREVENTION
Number of Arms
2
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Lead Sponsor