Effect of Topical Vancomycin Powder on Surgical Site Infections in Cranioplasty: A Systematic Review and Meta-Analysis.

Abstract

Surgical site infections remain a significant complication after cranioplasty, increasing morbidity, hospitalization, and the need for reoperation. While intrawound vancomycin powder has shown efficacy in reducing surgical site infections in other neurosurgical procedures, its role in cranioplasty remains unclear. This systematic review and meta-analysis evaluated the effectiveness of vancomycin powder in preventing surgical site infections after cranioplasty. A comprehensive search of PubMed, Cochrane Library, and Embase was conducted through April 2025. Eligible studies included randomized controlled trials and observational studies comparing vancomycin powder versus no vancomycin powder in cranioplasty, reporting surgical site infection outcomes. Risk of bias was assessed. Pooled odds ratios with 95% confidence intervals were calculated using a random-effects model. Heterogeneity was assessed with I² statistics. Three retrospective observational studies were included. The results showed a non-significant trend toward reduced infection with vancomycin powder. Heterogeneity was moderate. Studies varied in vancomycin powder dosing, timing, implant materials, and surgical techniques. Overall risk of bias was moderate, mainly due to missing data. No vancomycin powder-related adverse events were reported. Current evidence suggests a non-significant trend toward surgical site infection reduction with intrawound vancomycin powder in cranioplasty. However, limited sample size, study heterogeneity, and retrospective designs preclude firm conclusions. High-quality randomized trials are needed to establish vancomycin powder's efficacy and safety in this context.