Cost analysis of laparoscopic gastric bypass practice using current Medicare reimbursement and practice costs

BACKGROUND: We performed a formal cost analysis of a hypothetical bariatric practice consisting of a surgeon, dietitian, clinical coordinator/office manager, receptionist, and certified medical assistant to determine whether a bariatric practice would have a difficult time surviving financially with the current Medicare reimbursement. METHODS: The number of possible cases was calculated for the 2005 calendar year. Most of the costs and assumptions were taken from an actual bariatric practice. The malpractice insurance premium (but not physician salary and benefits) was calculated into the practice cost. RESULTS: With a total of 231 days available for clinical work in 2005, 300 scheduled laparoscopic gastric bypasses could have been performed to allow for appropriate clinic time for new patient visits, postoperative visits, and annual visits. The total reimbursement from Medicare would have been $516,158, with most of the reimbursement coming from procedure fees ($407,063). The total practice cost would have been $444,592. Most of the costs were clinic staff salary and benefits ($207,065) and the malpractice premium ($55,150). The net difference of $71,566 was left to pay the salary and benefits of the bariatric surgeon. CONCLUSION: The low reimbursement of Medicare for laparoscopic gastric bypass threatens the financial viability of a bariatric surgery practice. With the increasing cost of malpractice and the threatened decrease in Medicare physician reimbursement, Medicare recipients could see a decrease in the number of bariatric surgeons offering them service.     

Medicare Reimbursement for Hip and Knee Arthroplasty From 2000 to 2019: An Unsustainable Trend

BackgroundWhile reimbursement models for physicians continue to evolve, limited data exist regarding recent trends in physician reimbursement for hip and knee arthroplasty. The purpose of this study is to evaluate monetary trends in Medicare reimbursement rates from 2000 to 2019 for the most common hip and knee arthroplasty procedures.MethodsThe American Academy of Orthopedic Surgeons coding reference was queried to determine the Current Procedural Terminology codes most frequently used in hip and knee adult reconstruction. Next, the Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services was queried for each Current Procedural Terminology code, and physician fee data were extracted. All monetary data were adjusted for inflation using the consumer price index and expressed in 2019 US dollars. The average annual and the total percent change in reimbursement were calculated based on these adjusted trends for all procedures.ResultsAfter adjusting for inflation, the average physician reimbursement decreased by 31.9% for all hip arthroplasty procedures and by 33.3% for all knee arthroplasty procedures from 2000 to 2019. During this period, primary total hip arthroplasty physician fees decreased by 37.1% and primary total knee arthroplasty fees decreased by 40.6%. From 2000 to 2019, the inflation-adjusted reimbursement rate for all procedures decreased by an average of 1.7% per year.ConclusionThroughout the study period, physician reimbursement decreased for all knee and hip arthroplasty procedures. Increased awareness and consideration of these trends will be important for policy-makers, hospitals, and surgeons to assure equitable access to quality hip and knee arthroplasty care in the United States.     

Alterations in 90-day morbidity,mortality, and readmission rates following spine surgery in Medicare Accountable Care Organizations (2009–2014)

BACKGROUND CONTEXT

The impact of Accountable Care Organizations (ACOs) on healthcare quality and outcomes, including morbidity, mortality, and readmissions, has not been substantially investigated, especially following spine surgery.

Inpatient and 90-day post-discharge outcomes in elective Medicare spine fusion surgery

Background Context

Elective spine surgery is a commonly performed operative procedure, that requires knowledge of risk-adjusted results to improve outcomes and reduce costs.

中国脊柱外科发展历程

脊柱外科是建立在现代医学、脊柱矫形内植物和生物力学基础上的骨科学重要分支之一。随着生物科学的发展、材料学和工程学的密切结合,以及新医疗技术的出现,脊柱外科也得以不断的发展和完善。中国的脊柱外科学组成立于1985年,我国学者在各方面都进行了大量的工作,例如脊柱骨折脱位和/或脊髓神经损伤、脊柱感染、脊柱肿瘤、脊柱退行性疾病等疾病的治疗,以及基础研究方面。同时中国的脊柱外科学者还独立开发了很多新的技术和方法,在基础理论和临床实践方面均取得了长足的进步。近年来,通过增加国内国际的交流,我国的脊柱外科水平迅速提高,某些领域已达到世界先进水平。本文从我国脊柱外科学组的成立、脊柱手术学、脊柱内固定技术、微创技术及基础研究等方面简要回顾了我国脊柱外科的发展历程,希望借此推动和促进我国脊柱外科的发展。     

胸腔镜辅助下小切口在胸椎前路手术的临床应用

目的探讨胸腔镜辅助下小切口行胸椎前路手术的可行性. 方法 2001年10月～2002年10月,我院在胸腔镜辅助下小切口行胸椎前路手术14例.其中6例胸椎转移瘤行病变椎体切除、钢板骨水泥椎体重建及前路针棒内固定;4例胸椎结核行病灶清除、植骨及前路钉棒内固定;2例胸椎间盘突出症行髓核摘除、椎间植骨融合;2例胸椎椎体骨折合并脱位行脱位椎体复位、椎管减压、椎体间植骨及前路钉棒内固定. 结果术后影像学显示病灶清除彻底,内固定效果确切.14例术后随访 4～12个月,14例胸背痛完全消失,13例脊髓压迫症中除1例转移瘤无改善外,其余12例肌力术前A～D级,术后恢复至C～E级. 结论胸腔镜辅助下小切口行胸椎前路手术方法可行,近期疗效满意.     

A simple method for bone-graft handling during spine surgery

Morsellized bone-graft handling during spine surgery to get vertebral fusion can be a slow, laborious and time-consuming procedure. It is not absolutely exempt from complication risk. An easy, quick and inexpensive alternative technique is described.     

An evidence-based clinical guideline for antibiotic prophylaxis in spine surgery

Background context

The North American Spine Society's (NASS) Evidence-Based Clinical Guideline on Antibiotic Prophylaxis in Spine Surgery provides evidence-based recommendations to address key clinical questions regarding the efficacy and the appropriate antibiotic prophylaxis protocol to prevent surgical site infections in patients undergoing spine surgery. The guideline is intended to address these questions based on the highest quality clinical literature available on this subject as of June 2011.

Purpose

Provide an evidence-based educational tool to assist spine surgeons in preventing surgical site infections.

Study design

Systematic review and evidence-based clinical guideline.

Methods

This guideline is a product of the Antibiotic Prophylaxis in Spine Surgery Work Group of NASS Evidence-Based Guideline Development Committee. The work group consisted of neurosurgeons and orthopedic surgeons who specialize in spine surgery and are trained in the principles of evidence-based analysis. A literature search addressing each question and using a specific search protocol was performed on English language references found in MEDLINE (PubMed), ACP Journal Club, Cochrane Database of Systematic Reviews Database of Abstracts of Reviews of Effectiveness, Cochrane Central Register of Controlled Trials, EMBASE (Drugs and Pharmacology), and Web of Science to identify articles published since the search performed for the original guideline. The relevant literature was then independently rated using the NASS-adopted standardized levels of evidence. An evidentiary table was created for each of the questions. Final recommendations to answer each clinical question were developed via work group discussion, and grades were assigned to the recommendations using standardized grades of recommendation. In the absence of Levels I to IV evidence, work group consensus statements have been developed using a modified nominal group technique, and these statements are clearly identified as such in the guideline.

Results

Sixteen clinical questions were formulated and addressed, and the answers are summarized in this article. The respective recommendations were graded by the strength of the supporting literature, which was stratified by levels of evidence.

Conclusions

The clinical guideline for antibiotic prophylaxis in spine surgery has been created using the techniques of evidence-based medicine and best available evidence to aid practitioners in the care of patients undergoing spine surgery. The entire guideline document, including the evidentiary tables, suggestions for future research, and all the references, is available electronically on the NASS Web site at http://www.spine.org/Pages/PracticePolicy/ClinicalCare/ClinicalGuidlines/Default.aspx and will remain updated on a timely schedule.     

Patients insured by Medicare and Medicaid undergo lower rates of bariatric surgery

BackgroundAlthough the number of weight loss procedures is increasing, bariatric surgery is not used equitably in the United States. As obesity is more prevalent in minorities, higher priorities are placed toward improvement of access to care for these groups.ObjectivesTo evaluate whether patient insurance status has any effect on use of bariatric surgery for patients in New York State.SettingAdministrative statewide database.MethodsThe Statewide Planning and Research Cooperative System administrative database was used to identify all patients undergoing primary bariatric procedures between 2005 and 2016. Revision procedures were excluded from analysis. Multivariable logistic regression models were used to compare outcomes among patients with different payor status after controlling for confounding factors.ResultsAfter the application of inclusion and exclusion criteria, there were 125,666 bariatric records from 2005 to 2016. Most patients had commercial insurance (n = 106,148, 84.5%), followed by Medicare (n = 9355, 7.4%), Medicaid (n = 7939, 6.3%), and other/unknown (n = 2224, 1.8%). The percentage of Medicaid was estimated to be increase by 12%/yr and the percentage of Medicare was estimated to be increase by 5%/yr during 2005 to 2016. Univariate analysis showed that patients with different insurance types were significantly different in terms of age, sex, race, region, subtype of surgeries, most co-morbidities, overall complication, 30-day readmission/emergency department visits, and length of stay (P values < .0001). After adjusting for other confounding factors, patients with Medicare insurance had significantly higher risk of having overall complications, 30-day readmissions/emergency department visits, and longer length of stay.ConclusionsThe majority of patients undergoing bariatric surgery are insured by private insurance, whereas only 13.7% of bariatric surgeries are performed on patients with public insurance.     

Impact of cost valuation on cost-effectiveness in adult spine deformity surgery

Background Context

Over the past decade, the number of adult spinal deformity (ASD) surgeries has more than doubled in the United States. The complex surgeries needed to manage ASD are associated with significant resource utilization and high cost, making them a primary target for increased scrutiny. Accordingly, it is important to not only demonstrate value in ASD surgery as clinical effectiveness but also to translate outcome assessment to cost-effectiveness.

Enhanced recovery after surgery (ERAS) protocol in spine surgery

Enhanced recovery after surgery (ERAS) protocols are a set of interventions which are carried out in the preoperative and perioperative period. They are aimed to decrease the harmful effects of surgery on the body and help the patient recover better post-surgery. The effectiveness of ERAS has been well established in various other surgical specialities. Earlier spine surgery was thought to be very complex for application of ERAS protocols. However, this has changed over the last decade with (ERAS) protocols gaining widespread popularity in spine surgery. Initial studies involving ERAS in spine surgery were limited to lumbar spine. However, over the years the horizon of ERAS has expanded to include anterior cervical surgeries, spine deformity, spinal tumors and spine surgery in the elderly. ERAS has been shown to reduce the length of hospital stay, overall hospital costs, opioid consumption in perioperative and postoperative period and to lower complication rates in spine surgery. In this narrative review, we discuss various aspects of ERAS in spine surgery including the benefits of ERAS in spine surgery, the various components of preoperative, intraoperative and postoperative measures of ERAS protocol.     

Prevalence of osteoporosis in patients requiring spine surgery: incidence and significance of osteoporosis in spine disease

Summary The purpose of this study is to evaluate the incidence of osteoporosis in patients requiring spine surgery. Among patients older than 50 years, the rate of osteoporosis in males was 14.5% and the rate osteoporosis in females was 51.3%. We strongly recommend an evaluation and treatment for osteoporosis in the patients requiring spine surgery, especially in females over 50 years old. Introduction Because lifespan is increasing, there is an increase in the incidence of osteoporosis in elderly spine surgery patients. The osteoporosis may adversely influence the fusion rate and the surgical outcome. The purpose of this study is to evaluate the incidence of osteoporosis in patients requiring spine surgery. Methods A total of 1,321 patients underwent spine surgeries at our institute from January 1, 2005 to December 31, 2005. Among them, there were 562 patients (42.5%) younger than 50 years old, and 759 patients (57.6%) older than 50 years old. Prior to operation, we evaluated the patients for osteoporosis on both the femur head and lumbar spine by measuring the bone mineral density (BMD) by the dual-energy X-ray absorptiometry (DXA). Based on the World Health Organization (WHO) criteria for osteoporosis, we chose the T-score to determine normal (>−1), osteopenia (−1≥, >−2.5), and osteoporosis (≤−2.5). Among the 562 patients younger than 50 years, DXA was performed in 22 (3.9%) patients and there were 13 (2.3%) cases of osteopenia and 2 (0.3%) cases of osteoporosis. Results Among 759 patients older than 50 years, DXA was performed on 516 (68.0%) patients, 193 males and 323 females. Among the male patients, there were 89 (46.1%) patients with osteopenia and 28 (14.5%) with osteoporosis. Among the female patients, there were 134 (41.4%) with osteopenia and 166 (51.3%) with osteoporosis. The incidence of osteoporosis was higher in female patients and significantly increased with increasing age. Among 759 patients older than 50 years, 676 patients underwent a major spine operation with or without fusion. Among these patients, DXA was performed in 446 (66.0%) patients and there were 207 (46.4%) patients with osteopenia and 139 (31.1%) with osteoporosis. Conclusions The patients over 50 year-old who need spine operation have osteoporosis often. In conclusion, the number of spine operations in elderly patients is increasing and the incidence of osteoporosis in spine surgery patients is also increasing. We strongly recommend an evaluation for osteoporosis and post-operative treatment for osteoporosis in patients over 50 years old, especially for female patients.     

Dexmedetomidine versus nimodipine for controlled hypotension during spine surgery

BackgroundControlled hypotension is a technique that is used to limit intraoperative blood loss, improve operative field, decrease duration of surgery, and thus decrease the amount of blood transfused.ObjectiveThe aim of this double-blind, randomized, controlled study is to compare the effects of sevoflurane combined with dexmedetomidine (DEX) or nimodipine (NIMO) on blood loss in the surgical field, recovery time, and patient tolerability in spine surgery.MethodsForty-eight (48) patients, 20–50 years of age, ASA I-II, randomly divided into DEX group (n = 24) and NIMO group (n = 24). In the DEX group, a loading dose of DEX infused over 10 min at a rate of 1 μg/kg/h, followed by a maintenance rate of 0.4–0.8 μg/kg/h. In the NIMO group, the dose infused at 15 μg/kg/h for 2 h (approximately 1 mg/h). The infusion rates were titrated to maintain mean arterial pressure (MAP) of 60–65 mm. Hg. We recorded MAP, intraoperative blood loss, total recovery time, total fentanyl consumption, incidence of arrhythmia or ischemia, and postoperative nausea and vomiting.ResultsNo significant difference in the amount of blood loss between the two groups was observed. Total fentanyl consumption was significantly higher in the NIMO group (350 ± 8.9 μg) versus (200 ± 5.5 μg) in the DEX group (p = 0.002). Recovery time was shorter in the NIMO group (6.8 min) versus (8.9 min) in the DEX group (p = 0.001).ConclusionsDexmedetomidine and Nimodipine provided effective method of controlled hypotension limiting the blood loss, and NIMO was associated with significantly shorter extubation and recovery times compared with DEX.     

Buyer beware: analysis of changes to the 2021 Center for Medicare and Medicaid Services physician fee schedule for shoulder surgeons Medicare physician fee schedule changes

BackgroundBecause of budget neutrality rules in the United States Congress, the rates for reimbursable medical expenses with Medicare have been on a recent and consistent decline. The Center for Medicare and Medicaid Services (CMS) continued to proceed with cuts to the 2021 physician fee schedule. There has been an overall 3.3% decrease in the valuation of work relative value units per CMS guidelines. Conversely, CMS has increased the value of certain in office evaluation and management (E/M) services and changed the criteria for level of visit based on complexity of decision-making. The direct effects of these changes to shoulder and elbow surgeons are unknown. This study evaluates the effect of these changes in Medicare reimbursement from 2020 to 2021 among a group of high-volume shoulder and elbow surgeons.MethodsBilling data were queried for 9 fellowship-trained shoulder & elbow surgeons at a high-volume surgical practice from 2020 to 2021. Office-based E/M and surgical codes for shoulder arthroplasty and other common shoulder and elbow codes were used. We compared volume data and change to reimbursement using the 2020 and 2021 Medicare physician fee schedule. The impact of increased E/M billing levels using the new 2021 CMS criteria was also calculated and compared between years.ResultsComparing 2020 to 2021, there was a 18.7% decrease in level 3 visits (17,208 vs. 13,990) and a corresponding 371% increase in level 4 visits billed (1138 vs. 5362). Evaluating the overall impact of this shift on reimbursement from office-based E/M codes, there was a significant increase with an average of $57,954 per surgeon (range = $20,394-$118,916) for this group of 9 surgeons. However, surgical reimbursement for most commonly performed arthroscopic and open shoulder and elbow procedures decreased for 5 of 9 surgeons, with an average decrease of $13,015 (range = ?$80,980 to $44,246). When arthroplasty reimbursements were combined with those for other common procedures, there was a decreased surgical reimbursement, totaling $117,135 for all surgeons combined.ConclusionIn this practice of 9 high-volume shoulder and elbow surgeons, a significant decrease in CMS reimbursement related to surgical procedural reimbursement from 2020 to 2021 was experienced. However, increasing the rates of E/M reimbursement and the augmented visit level rules helped offset and exceed the lost revenue from surgical procedures. Caution must be taken: this one time increase in office-based billing coupled with continued annual cuts to surgical procedure valuation is not a sustainable model moving forward.Level of EvidenceLevel IV; Retrospective Case Series; Economic Model.     

Anesthesia for video-assisted surgery of the thoracic and lumbar spine: a survey of 44 patients

INTRODUCTION: The development of video-assisted surgery of the dorsolumbar spine has led to the need for adaptations for appropriate anesthetic management. Data concerning anesthesia for such surgery is very sparse in the literature. AIM OF THE STUDY: The aim of this retrospective study of 44 patients was to learn more about anesthesia practices used for patients undergoing this type of surgery. PATIENTS AND METHOD: The files of 44 patients were studied retrospectively. Epidemiologic data and the perioperative phase were analysed. RESULTS: The preoperative phase was not specific with preoperative assessment adapted to each patient. Similarly, monitoring practices during the surgical procedure were not specific. The choice of the anesthetic agents depended on the patient's clinical status. For tracheal intubation, care was taken to enable lung exclusion, even if not often used. Thoracic drainage at the end of the surgery was required in the event of imperfect hemostasis and in selected patients was replaced by pneumothorax exsufflation during closure. The postoperative period was uneventful and did not require admission to intensive care; non-specific analgesia was used. DISCUSSION: Adaptations of anesthetic practices are required each time a new surgical technique is developed. Excepting lung exclusion, anesthesia for video-assisted dorsolumbar spine surgery is not specific.     

Image-guided spine surgery: state of the art and future directions

Navigation technology is a widely available tool in spine surgery and has become a part of clinical routine in many centers. The issue of where and when navigation technology should be used is still an issue of debate. It is the aim of this study to give an overview on the current knowledge concerning the technical capabilities of image-guided approaches and to discuss possible future directions of research and implementation of this technique. Based on a Medline search total of 1,462 publications published until October 2008 were retrieved. The abstracts were scanned manually for relevance to the topics of navigated spine surgery in the cervical spine, the thoracic spine, the lumbar spine, as well as ventral spine surgery, radiation exposure, tumor surgery and cost-effectivity in navigated spine surgery. Papers not contributing to these subjects were deleted resulting in 276 papers that were included in the analysis. Image-guided approaches have been investigated and partially implemented into clinical routine in virtually any field of spine surgery. However, the data available is mostly limited to small clinical series, case reports or retrospective studies. Only two RCTs and one metaanalysis have been retrieved. Concerning the most popular application of image-guided approaches, pedicle screw insertion, the evidence of clinical benefit in the most critical areas, e.g. the thoracic spine, is still lacking. In many other areas of spine surgery, e.g. ventral spine surgery or tumor surgery, image-guided approaches are still in an experimental stage. The technical development of image-guided techniques has reached a high level as the accuracies that can be achieved technically meet the anatomical demands. However, there is evidence that the interaction between the surgeon (‘human factor’) and the navigation system is a source of inaccuracy. It is concluded that more effort needs to be spend to understand this interaction.     

Surface-based registration accuracy of CT-based image-guided spine surgery

Registration is a critical and important process in maintaining the accuracy of CT-based image-guided surgery. The aim of this study was to evaluate the effects of the area of intraoperative data sampling and number of sampling points on the accuracy of surface-based registration in a CT-based spinal-navigation system, using an optical three-dimensional localizer. A cadaveric dry-bone phantom of the lumbar spine was used. To evaluate registration accuracy, three alumina ceramic balls were attached to the anterior and lateral aspects of the vertebral body. CT images of the phantom were obtained (1-mm slice thickness, at1-mm intervals) using a helical CT scanner. Twenty surface points were digitized from five zones defined on the basis of anatomical classification on the posterior aspects of the target vertebra. A total of 20 sets of sampling data were obtained. Evaluation of registration accuracy accounted for positional and rotational errors. Of the five zones, the area that was the largest and easiest to expose surgically and to digitize surface points was the lamina. The lamina was defined as standard zone. On this zone, the effect of the number of sampling points on the positional and rotational accuracy of registration was evaluated. And the effects of the additional area selected for intraoperative data sampling on the registration accuracy were evaluated. Using 20 surface points on the posterior side of the lamina, positional error was 0.96 mm±0.24 mm root-mean-square (RMS) and rotational error was 0.91°±0.38°RMS. The use of 20 surface points on the lamina usually allows surgeons to carry out sufficiently accurate registration to conduct computer-aided spine surgery. In the case of severe spondylosis, however, it might be difficult to digitize the surface points from the lamina, due to a hypertrophic facet joint or the deformity of the lamina and noisy sampling data. In such cases, registration accuracy can be improved by combining use of the 20 surface points on the lamina with surface points on other zones, such as on the both sides of the spinous process.Part of this study was presented at the CAOS USA 2000 meeting in Pittsburgh     

SSEP analysis in surgery of idiopathic scoliosis: the influence of spine deformity and surgical approach

The study was conducted to assess the possible impact of spine deformity in patients with idiopathic scoliosis (IS) on tibial nerve somatosensory evoked potentials (t-SSEPs) and the influence of spine correction upon postoperative SSEP recordings. In 61 consecutive patients undergoing 64 spinal instrumentations, 129 pre- and postoperative SSEPs were analyzed. The degree of spine deformity was assessed by the pre-operative Cobb angle of the major scoliotic curve. In a control group, reference values of t-SSEP latencies were established with respect to body height. In a cohort study, IS patients were compared with healthy controls with respect to t-SSEP latency, amplitude, configuration and interside difference. The results of the analysis showed that preoperative-body-height-corrected t-SSEP latencies were prolonged in 61% of patients, with a pathological interside difference in 23.4% of them. The impairment of t-SSEPs was not related to the extent of spine deformity as assessed by the Cobb angle. Even without occurrence of postoperative neurological deficits, postoperative t-SSEPs showed significantly increased latencies without changes in t-SSEP configuration. The prolongation of t-SSEP latencies was related to the surgical procedure (combined ventro-dorsal approach), but not to the extent of spine correction, level of instrumentation, or number of fused segments.The analysis of preoperative t-SSEPs was of no predictive value for intra- or postoperative neurological complications. t-SSEPs are significantly affected in IS patients, although these patients show no obvious clinical neurological deficits. The extent of t-SSEP impairment is not related to the severity of scoliosis. Even in clinically uneventful surgery, the postoperative t-SSEPs can be deteriorated depending on the surgical approach. This indicates a subclinical impact of spine surgery upon spinal cord function.     

Positioning patients for spine surgery: Avoiding uncommon position-related complications

Positioning patients for spine surgery is pivotal for optimal operating conditions and operative-site exposure. During spine surgery, patients are placed in positions that are not physiologic and may lead to complications. Perioperative peripheral nerve injury (PPNI) and postoperative visual loss (POVL) are rare complications related to patient positioning during spine surgery that result in significant patient disability and functional loss. PPNI is usually due to stretch or compression of the peripheral nerve. PPNI may present as a brachial plexus injury or as an isolated injury of single nerve, most commonly the ulnar nerve. Understanding the etiology, mechanism and pattern of injury with each type of nerve injury is important for the prevention of PPNI. Intraoperative neuromonitoring has been used to detect peripheral nerve conduction abnormalities indicating peripheral nerve stress under general anesthesia and to guide modification of the upper extremity position to prevent PPNI. POVL usually results in permanent visual loss. Most cases are associated with prolonged spine procedures in the prone position under general anesthesia. The most common causes of POVL after spine surgery are ischemic optic neuropathy and central retinal artery occlusion. Posterior ischemic optic neuropathy is the most common cause of POVL after spine surgery. It is important for spine surgeons to be aware of POVL and to participate in safe, collaborative perioperative care of spine patients. Proper education of perioperative staff, combined with clear communication and collaboration while positioning patients in the operating room is the best and safest approach. The prevention of uncommon complications of spine surgery depends primarily on identifying high-risk patients, proper positioning and optimal intraoperative management of physiological parameters. Modification of risk factors extrinsic to the patient may help reduce the incidence of PPNI and POVL.     

稀碘伏溶液浸泡术野对降低术后脊柱手术切口感染风险的效果

目的 :评价在脊柱手术关闭切口前使用稀碘伏溶液浸泡术野对降低术后切口感染的效果。方法 :搜集从2010年1月~2014年12月由我院骨科同一术者实施手术的患者资料,排除其中椎体成形手术、原发感染手术、Halo头环固定术、椎间孔镜手术及内固定取出手术。共计纳入706例满足条件的脊柱手术患者作为观察对象。对照组为2010年1月~2012年12月进行的311例脊柱手术患者,在关闭切口前使用1000~1500ml生理盐水冲洗术野。观察组为2013年1月~2014年12月进行的395例脊柱手术患者,在关闭切口前使用1%的稀碘伏溶液浸泡术野2min后用生理盐水冲洗一遍。观察术后两组患者切口感染发生情况,并对两组变量和感染率进行统计学分析。结果:观察组和对照组患者在年龄、性别、BMI指数、贫血人数、低蛋白血症人数、糖尿病人数、手术入路、节段涉及、术中失血量、术中输血量等指标上没有统计学差异(P0.05)。对照组311例患者中9例(2.9%)发生了术后切口感染,2例(0.6%)为表浅切口感染,7例(2.3%)为深部切口感染;观察组395例患者中仅1例(0.2%)发生切口感染,为浅表切口感染。两组患者在总切口感染率(P=0.009)和深部切口感染率(P=0.009)上有统计学差异。单因素分析结果显示是否使用稀碘伏溶液浸泡是影响术后感染的重要因素。结论:在脊柱手术关闭切口前使用稀碘伏溶液浸泡术野是一种有效、简单、廉价、值得推荐的能降低术后切口感染风险的方法。但其更确切的效果以及最佳的标准化操作方法有待更大规模、证据等级更高的研究予以揭示。