IMPORTANCE To help prevent surgical site infections (SSIs), recommendations by a national organization led to implementation of a mandatory operating room policy in a large multicenter health care organization of required use of disposable perioperative jackets.OBJECTIVE To assess whether the use of perioperative disposable jackets is associated with the incidence of SSIs. DESIGN, SETTING, AND PARTICIPANTS Surgical site infection data for patients undergoing clean surgical procedures were retrospectively reviewed from 12 hospitals in a large multicenter health care organization during a 55-month period from January 1, 2014, to July 31, 2018. The incidence of SSI was analyzed for all National Healthcare Safety Network monitored and reported procedures. The patient population was split into 2 groups; the preintervention group consisted of 29 098 patients within the 26 months before the policy starting March 1, 2016, and the postintervention group consisted of 30 911 patients within 26 months after the policy. MAIN OUTCOME AND MEASURESComparison of the incidence of SSIs before and after intervention periods underwent statistical analysis. The total number of disposable jackets purchased and total expenditures were also calculated.EXPOSURES Implementation of the mandated perioperative attire policy.RESULTS A total of 60 009 patients (mean [SD] age, 62.8 [13.9] years; 32 139 [53.6%] male) were included in the study. The overall SSI incidence for clean wounds was 0.87% before policy implementation and 0.83% after policy implementation, which was not found to be significant (odds ratio [OR], 0.96; 95% CI, 0.80-1.14; P = .61). After accounting for possible confounding variables, a multivariable analysis demonstrated no significant reduction in SSIs (OR, 0.85; 95% CI, 0.71-1.01; P = .07). During the postintervention study period (26 months), a total of 2 010 040 jackets were purchased, which amounted to a cost of $1 709 898.46. CONCLUSIONS AND RELEVANCEThe results of this study suggest that the use of perioperative disposable jackets is not associated with reductions in SSI for clean wounds in a large multicenter health care organization and presents a fiscal burden.

Background Safely performing instrumented spinal fusion requires an intimate knowledge of anatomy and variations. Pedicle screw position and size have implications on intraoperative and post-operative complications. While pre-operative planning with Computed Tomography (CT) scan measurements may be the safest way to judge trajectory and maximal screw size, it is not standard practice for many spine surgeons. We investigated how height and weight correlated with PD. We hypothesized that these routinely obtained, non-invasive measurements would provide an easily referenced data point to aid in perioperative estimation of maximum safe pedicle screw diameter (MSPSD). Methods Coronal cuts of the lumbar spine were assessed to obtain transverse outer cortical PD as measured through the isthmus at lumbar vertebrae one through five. We assessed whether height, weight, and BMI significantly correlated with PD in our diverse population. Results Height and weight were found to significantly correlate with PD. Height explained roughly 10% of the variance in PD, weight explained only 3-4%, and BMI nearly 0%. There were significant differences in this theoretical safety profiles between the "Taller Height" and "Shorter Height" groups for the majority of pedicle screw sizes at L1 through L3. Significant differences between the populations at L4 and L5 were only seen for 8.0 mm screws at the L4 level. At L5, 100% of the "Taller Height" and "Shorter Height" subjects' pedicles could safely accommodate pedicle screws up to 8.0 mm in diameter. Conclusions We previously reported on the significant difference in PD between different races. The results of this study provide yet another variable to be considered when making radiographic assessments of pedicle diameter.

Study Design. Retrospective review.Objective. The objective of this study was to report on one institution's use of single bolus micro-dose intrathecal morphine as part of a rapid recovery pathway during posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and its comparison to patients whose pain was controlled with patientcontrolled analgesia (PCA). Summary of Background Data. Narcotic substance addiction has risen across all patient populations, including pediatrics. Narcotics have been historically used in complex spine surgeries as a measure of pain control, predominantly provided as PCA and additional take-home medication. Methods. AIS patients undergoing PSF from 2015 to 2019 were reviewed. In 2018, we instituted a standardized rapid recovery pathway for scoliosis patients undergoing PSF utilizing microdose intrathecal morphine (ITM-RRP). Before this, traditional protocol with PCA was used for postoperative management. Perioperative data, morphine consumption and prescription refill requests were compared.Results. There were 373 AIS patients total in this study, of which 250 patients were in the PCA group and 123 in the ITM-RRP Group. Preoperative Cobb angles (P ¼ 0.195), as well as levels fused (P ¼ 0.481) and body mass index (P ¼ 0.075) were similar. 69.4% of ITM-RRP patients had a length of stay 3 days, significantly >11.6% of PCA patients (P < 0.001). ITM-RRP patients began ambulating significantly earlier with 84.6% patients out of bed by postoperative day 1 versus 8% PCA patients (P < 0.001). Additionally, ITM-RRP patients had significantly lower VAS pain scores with activity and earlier initial bowel movements (P < 0.001). Postoperative emesis was similar (P ¼ 0.11). No patients had pruritus, respiratory depression, or required supplemental oxygenation. Conclusion. This is the first study to show that a rapid recovery protocol utilizing single micro-dose ITM with oral analgesics have adequate recovery, significantly better postoperative pain control and superior perioperative outcomes to traditional protocols using PCA in the AIS population following PSF.

BackgroundSpinal surgery requires an intimate understanding of pedicle morphology to provide safe and effective outcomes. Although current research has attempted to identify morphological vertebral pedicle trends, no study has utilized computed tomography (CT) scans to compare the lumbar transverse pedicle angle (TPA) with patient demographics factors in a diverse population throughout multiple hospital centers.MethodsAnalysis of randomly selected CT scans from L1-L5 of 97 individuals who underwent imaging over a two-week period for non-back pain related complaints was conducted. Measuring 970 TPAs in total allowed for comparison of each patients’ pedicle angle with important patient specific demographics including ethnicity, age, gender, height and weight. Statistical analysis utilized multiple comparisons of demographics at each level with post-hoc Bonferroni correction analysis to compare demographics at each level.ResultsWith relation to gender, age, height or weight, no statistically significant differences were identified for TPAs at any vertebral level. However, when stratified by ethnicity, the differences in transverse pedicle angles averages (TPA –Avg) at L2 and L3 were found to be statistically significant (p < 0.05).ConclusionWe have identified a previously unknown and significant relationship between ethnicity and TPA at lumbar vertebral levels. These findings provide critical information that may be added to the operating surgeons’ knowledge of pedicle morphology. We hope this novel information can assist in preoperative planning of pedicle screw placement and potentially help improve surgical outcomes.