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Do Surgical Site Infection Rates Differ Among Microscope-assisted Versus Loupe-assisted Lumbar Discectomies?
Adan Omar1, Scott Ecternacht, Etka Kurucan
1Department of Orthopaedic Surgery, University of Rochester School of Medicine, Rochester, NY.
Study Design:
Retrospective study.
Objective:
The objective of this study was to compared surgical site infection (SSI) rates between patients under lumbar discectomy with an operative microscope versus surgical loupes.
Summary Of Background Data:
Lumbar decompressions for herniated disks or lumbar stenosis are common spine procedures. Some studies have raised the concern that drape contamination of the operative microscope may be an additional risk for SSIs. We hypothesize that the use of the operative microscope for lumbar decompression procedures does not increase infection rates.
Methods:
A retrospective cohort analysis was performed on patients undergoing lumbar spinal decompressions via microscopic assistance (MA) or loupe assistance (LA) by 2 orthopedic spine surgeons at a tertiary academic medical center. Patients treated from November, 2012 to October, 2016 were enrolled. Variables including age, sex, race, body mass index, smoking status, length of surgery, intraoperative complications, estimated blood loss, and postoperative SSIs within 30 days were collected.
Results:
A total of 225 patients were included in the study. Sixty-three patients underwent LA lumbar decompression, and 162 underwent MA lumbar decompression. There were 72 female individuals/90 male individuals in the MA group and 31 female individuals/33 male individuals in the LA group. The MA was significantly older 45.2 versus 40.4 in LA, P-value of 0.02 and had a significantly higher body mass index (30.64 vs. 27.79, P<0.002). SSI rates were not significantly different, MA 3.7% (6/162) and LA 7.9% (5/63), P-value of 0.14. The MA group had a significantly longer operative time (92 vs. 50 min, P<0.001). Dural tears rates were 3.1% in MA and 1.6% in LA, P-value of 0.3 and were associated with longer operative time in the MA group, 162.2 versus 90.2 minutes, P-value of <0.0001. Multivariate regression analysis did not identify any significant differences between the 2 groups.
Conclusions:
The use of the operative microscope had similar infection rates as LA microdiscectomies. In academic institutions, the operative microscope may allow more opportunities for residents or fellows to partake/assist in the procedure as compared with LA procedures.
Insights
This study found no significant difference in surgical site infection rates between microscopic assistance (MA) and loupe assistance (LA) for lumbar discectomy. Both methods are safe for spinal decompression procedures, with similar outcomes regarding infection risk.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Infectious Disease Control
Background:
- Lumbar decompression for herniated discs and stenosis are common.
- Concerns exist regarding potential increased surgical site infection (SSI) risk with operative microscopes due to drape contamination.
- This study addresses the hypothesis that operative microscopes do not elevate infection rates in lumbar decompression.
Purpose of the Study:
- To compare surgical site infection (SSI) rates in patients undergoing lumbar discectomy using an operative microscope versus surgical loupes.
- To evaluate the safety and efficacy of microscopic assistance (MA) versus loupe assistance (LA) in lumbar decompression procedures.
Main Methods:
- A retrospective cohort analysis of 225 patients undergoing lumbar spinal decompression.
- Patients were divided into two groups: microscopic assistance (MA) and loupe assistance (LA).
- Data collected included patient demographics, surgical details, and postoperative SSIs within 30 days.
Main Results:
- No significant difference in SSI rates between MA (3.7%) and LA (7.9%) groups (P=0.14).
- The MA group had significantly longer operative times (92 vs. 50 minutes, P<0.001) and higher body mass index.
- Dural tear rates were similar between groups (3.1% MA vs. 1.6% LA, P=0.3).
Conclusions:
- Operative microscope use in lumbar decompression yields comparable infection rates to loupe assistance.
- Microscopic assistance may offer educational benefits for trainees in academic settings.
- Both MA and LA are viable and safe options for lumbar decompression surgery regarding infection risk.
