Study Design. Prognostic study, Level III. Objectives. The aim of this study was to determine the incidence and demographics of idiopathic scoliosis (IS) in a large cohort of children in a Southern California integrated healthcare system, and to identify the demographic or clinical factors associated with the greatest risk of IS. Summary of Background Data. Although many authors have reported on the incidence and prevalence of IS in children, there have been few incidence studies in the United States on large, self-contained populations. Methods. A retrospective chart analysis was done on diagnosed cases of IS within our integrated health care system in patients under age 18 years during the entire 2013 calendar year. Patient demographics were recorded and the incidence of IS was determined. Odds ratios (ORs) for having IS and for having more severe initial curve magnitudes based on demographics were determined using logistic regression models. Results. IS Incidence was 3.9, 28.6, and 393 per 100,000, respectively, for the infantile, juvenile, and adolescent group. The female incidence was more than twice that of males in all age groups. Multivariate logistic regression analysis showed Asians and non-Hispanic Whites had the highest OR of IS (OR 1.54 and 1.32 with 95% confidence interval [CI] 1.33-1.79 and 1.19-1.47). Whites, Blacks, and mixed-race patients had a significantly higher initial curve magnitude than Hispanics; females also had a significantly greater initial curve magnitude than boys (18.18 vs. 16.78). Underweight patients had a 50% increased OR of IS versus normal weight (95% CI 1.16-1.94) with a progressively decreased OR of IS as weight increased. Conclusion. Our study of a large integrated healthcare system sheds light on the incidence of IS and the ORs based on weight, sex, and ethnicity/race. The overall incidence was lower overall than previously thought.

Study Design. Retrospective database review. Objective. The aim of this study was to determine the incidence of Clostridium difficile infection (CDI) within 90 days following elective spine surgery; examine risk factors associated with its development; and evaluate the impact of CDI on postoperative outcomes. Summary of Background Data. Although previous studies provided valuable insight into the rate of CDI following spine surgery and associated risk factors, to date no study has evaluated the role preoperative antibiotics use plays in the development of CDI, as well as its impact on 90-day outcomes. Methods. A retrospective database review of Humana patients ages 20 to 84 years who underwent elective spine surgery between 2008 and 2016 was conducted. Following exclusion criteria, the population was divided into patients who developed CDI within 90 days of surgery and those who did not. All risk factors and outcomes were analyzed using multivariate regression. Results. A total of 63,667 patients met study criteria. Ninety-day incidence of CDI was 0.68%. Notable medical risk factors (P < 0.05) included preoperative fluoroquinolone use (odds ratio [OR] 1.40), advanced age (OR 1.86), chronic kidney disease stage I/II (OR 1.76) and III-V (OR 1.98), decompensated chronic liver disease (OR 3.68), and hypoalbuminemia (OR 3.15). Combined anterior-posterior cervical (OR 2.74) and combined anterior-posterior lumbar (OR 2.43) approaches and procedures spanning more than eight levels (OR 3.99) were associated with the highest surgical risk (P < 0.05) of CDI. CDI was associated with a 12.77-day increase in length of stay (P < 0.05) and increased risk of readmission (OR 6.08, P < 0.05) and mortality (OR 8.94, P < 0.05). Conclusion. Following elective spine surgery, CDI increases risk of readmission and mortality. In addition to preoperative fluoroquinolone use, novel risk factors associated with the highest risk of CDI included decompensated chronic liver disease, posterior approaches, and multilevel involvement. Perioperative optimization of modifiable risk factors may help to prevent occurrence of CDI. Level of Evidence: 3

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