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Background: Current measures to prevent spinal surgical site infection (SSI) lack compliance and lead to antimicrobial resistance. We aimed to examine the effectiveness of bundled preoperative intranasal photodynamic disinfection therapy (nPDT) and chlorhexidine gluconate (CHG) body wipes in the prophylaxis of spine SSIs in adults, as well as determine our institutional savings attributable to the use of this strategy and identify adverse events reported with nPDT-CHG. Methods: We performed a 14-year prospective observational interrupted time-series study in adult (age > 18 yr) patients undergoing emergent or elective spine surgery with 3 time-specific cohorts: before rollout of our institution's nPDT-CHG program (2006-2010), during rollout (2011-2014) and after rollout (2015-2019). We used unadjusted bivariate analysis to test for temporal changes across patient and surgical variables, and segmented regression to estimate the effect of nPDT-CHG on the annual SSI incidence rates per period. We used 2 models to estimate the cost of nPDT-CHG to prevent 1 additional SSI per year and the annual cumulative cost savings through SSI prevention. Results: Over the study period, 13 493 patients (mean 964 per year) underwent elective or emergent spine surgery. From 2006 to 2019, the mean age, mean Charlson Comorbidity Index (CCI) score and mean Spine Surgical Invasiveness Index (SSII) score increased from 48.4 to 58.1 years, from 1.7 to 2.6, and from 15.4 to 20.5, respectively (p < 0.001). Unadjusted analysis confirmed a significant decrease in the annual number (74.6 to 26.8) and incidence (7.98% to 2.67%) of SSIs with nPDT-CHG (p < 0.001). After adjustment for mean age, mean CCI score and mean SSII score, segmented regression showed an absolute reduction in the annual SSI incidence rate of 3.36% per year (p < 0.001). The estimated annual cost to prevent 1 additional SSI per year was about $1350-$1650, and the estimated annual cumulative cost savings were $2 484856-S2 495 016. No adverse events were reported with nPDT-CHG. Conclusion: Preoperative nPDT-CHG administration is an effective prophylactic strategy for spinal SSIs, with significant cost savings. Given its rapid action, minimal risk of antimicrobial resistance, broad-spectrum activity and high compliance rate, preoperative nPDT-CHG decolonization should be the standard of care for all patients undergoing emergent or elective spine surgery. Contexte : L'application des mesures de prévention des infections des plaies opératoires (IPO) du rachis laisse actuellement à désirer et pourrait contribuer à la résistance aux antibiotiques. Nous avons voulu vérifier l'efficacité de la thérapie photodynamique antimicrobienne (TPA) intranasale préopératoire alliée à l'utilisation de lingettes désinfectantes à la chlorhexidine (LDC) pour le corps en prophylaxie des IPO du rachis chez des adultes, calculer les économies réalisées par notre établissement grâce à la stratégie TPD-LDC et recenser ses effets indésirables. Méthodes : Nous avons procédé à une étude observationnelle de séries chronologiques interrompues échelonnée sur une période de 14 ans chez des adultes (âgés de >18 ans) soumis à une chirurgie urgente ou non urgente du rachis auprès de 3 cohortes chronologiques spécifiques : avant le déploiement de la stratégie dans notre établissement (2006-2010), puis durant (2011-2014) et après son déploiement (2015-2019). Nous avons appliqué une analyse bivariée non ajustée pour vérifier les changements dans le temps selon la patientèle et les paramètres chirurgicaux, et segmenté la régression pour estimer l'effet de la stratégie TPA-LDC sur les taux d'incidence annuels moyens d'IPO par période. Nous avons utilisé 2 modèles pour estimer le coût de la stratégie TPA-LDC apte à prévenir une IPO additionnelle par année et les économies cumulatives annuelles moyennes générées par la prévention des IPO. Résultats : Durant la période de l'étude, 13 493 malades (964 par année en moyenne) ont subi une chirurgie urgente ou non urgente du rachis. Entre 2006 et 2011 et entre 2015 et 2019, l'âge moyen, l'indice moyen de comorbidité de Charlson (ICC) et l'indice moyen d'invasivité de la chirurgie du rachis (IICR) sont passés de 48,4 à 58,1 ans, de 1,7 à 2,6 et de 15,4 à 20,5, respectivement (p < 0,001). L'analyse non ajustée a confirmé une baisse significative du nombre annuel (de 74,6 à 26,8) et de l'incidence (de 7,98% à 2,67%) des IPO associée à la stratégie TPA-LDC (p < 0,001). Après ajustement pour tenir compte de l'âge, de l'ICC et de l'IICR moyens, la régression segmentée a montré une réduction absolue du taux d'incidence annuel des IPO de 3,36% par année (p < 0,001). Le coût annuel moyen estimé pour prévenir une IPO additionnelle a été d'environ 1350$-1650$, et les économies cumulatives annuelles moyennes estimées ont été de 2484856 $-2 495 016$. Aucun effet indésirable n'a été signalé avec la stratégie TPA-LDC. Conclusion : L'application préopératoire de la stratégie TPA-LDC est une mesure prophylactique efficace pour les IPO du rachis, et donne lieu à des économies significatives. Compte tenu de sa rapidité d'action, du risque minimal de résistance aux antibiotiques, de son activité à large spectre et du taux d'observance élevé, la décolonisation préopératoire par TPA-LDC devrait être une norme de soins pour l'ensemble de la patientèle soumise à une chirurgie urgente ou non urgente du rachis., Surgical site infections (SSIs) are devastating postoperative complications associated with substantial morbidity, prolonged length of stay (LOS) and increased health care-related costs. (1) The rate of SSIs after spine surgery [...]

Background: Surgery for degenerative spine pathologies is typically performed on a scheduled basis; however, worsening symptoms may warrant emergency surgery. An increasing number of patients requiring emergency surgery has been observed (22.6% in 2006 to 34.8% in 2019). We sought to compare the outcomes of patients who received scheduled surgery and those who required emergency surgery. Methods: All patients treated between Jan. 1, 2006, and Dec. 31, 2019, were included. Retrospective comparisons were made between patients who were scheduled (elective) for surgery and those requiring emergency surgery, patients who were scheduled for surgery and those who decompensated while on the surgical waitlist and patients who presented as de novo emergencies and those who decompensated while on the surgical waitlist. Results: Among the 6217 patients with degenerative pathologies, 4654 (74.9%) patients were scheduled (elective) for surgery and 1563 (25.1%) were patients requiring emergency surgery. Compared with patients who were scheduled, patients requiring emergency surgery had a longer length of stay (LOS) in hospital (5.1 d, interquartile range [IQR] 2.7-11.2 v. 3.6 d, IQR 1.3-6.4, p < 0.001) and lower rate of home discharge (78.6% v. 94.2%, p < 0.001). Patients requiring emergency surgery were 1.34 times more likely to have any adverse events (95% confidence interval [CI] 1.06-1.68, p = 0.01). When compared with patients who were scheduled for surgery, those who decompensated while on the surgical waitlist had longer LOS (7.0 d, IQR 3.3-15.0 v. 3.6 d, IQR 1.3-6.4, p < 0.001), less home discharge (77.6% v. 94.2%, p < 0.001) and were 2.5 times more likely to have any adverse events (95% CI 1.5-4.1, p < 0.001). Patients who decompensated had a 2.1 times higher risk of having any adverse events than patients who presented as de novo emergencies (95% CI 1.2-3.6, p< 0.001). Conclusion: We observed worse perioperative outcomes for patients requiring emergency surgery for degenerative spinal conditions than for patients who were scheduled for surgery. Patients who decompensated while on the surgical waitlist had the worst outcomes. Contexte: Le traitement chirurgical des pathologies dégénératives de la colonne vertébrale est généralement planifié; l'aggravation des symptômes peut toutefois justifier une opération d'urgence. On constate d'ailleurs qu'un pourcentage croissant de patients ont besoin d'une telle intervention (22,6% en 2006 comparativement à 34,8% en 2019). Nous avons cherché à comparer les issues des patients ayant subi une intervention planifiée avec celles des patients nécessitant une opération d'urgence. Méthodes: Tous les patients traités entre le 1er janvier 2006 et le 31 décembre 2019 ont été inclus. Nous avons établi des comparaisons rétrospectives entre les patients allant subir une intervention planifiée (non urgente) et ceux ayant besoin d'une opération d'urgence, entre les patients allant subir une intervention planifiée et ceux ayant subi une décompensation alors qu'ils étaient sur une liste d'attente, et entre les patients nécessitant une opération urgente pour une pathologie de novo et ceux ayant subi une décompensation alors qu'ils étaient sur une liste d'attente. Résultats: Parmi les 6217 patients présentant des pathologies dégénératives, 4654 (74,9%) allaient subir une intervention planifiée (non urgente) et 1563 (25,1%) avaient besoin d'une opération d'urgence. Comparativement aux premiers, ces derniers restaient plus longtemps à l'hôpital (5,1 jours [écart interquartile (EI) 2,7-11,2] c. 3,6 jours [EI 1,3-6,4], p < 0,001) et présentaient un taux de congé plus faible (78,6% c. 94,2%, p < 0,001). Ils étaient 1,34 fois plus susceptibles d'être victimes d'un événement indésirable (intervalle de confiance [IC] de 95% 1,06-1,68, p = 0,01). Comparativement aux patients pour lesquels une intervention était prévue, ceux ayant subi une décompensation alors qu'ils étaient sur une liste d'attente restaient plus longtemps à l'hôpital (7,0 jours [EI 3,3-15,0] c. 3,6 jours [EI 1,3-6,4], p < 0,001), présentaient un taux de congé plus faible (77,6% c. 94,2%, p < 0,001) et étaient 2,5 fois plus susceptibles de subir un événement indésirable (IC de 95% 1,5-4,1, p < 0,001). Les patients ayant subi une décompensation présentaient un risque 2,1 fois plus élevé d'être victimes d'un événement indésirable, comparativement aux patients nécessitant une opération urgente pour une pathologie de novo (IC de 95% 1,2-3,6, p < 0,001). Conclusion: Nous avons observé des issues périopératoires moins favorables chez les patients ayant besoin de se faire opérer d'urgence pour des pathologies dégénératives de la colonne vertébrale, comparativement à ceux pour lesquels une intervention était prévue. Les patients ayant subi une décompensation alors qu'ils étaient sur une liste d'attente présentaient les pires issues., Older age demographics have increased the demand for spinal surgery, creating an ever-increasing burden for the health care system. (1) This is especially true for degenerative spinal pathologies such as [...]

Study Design: Retrospective observational cohort study. Objective: En bloc resection for primary tumours of the spine is associated with a high rate of adverse events (AEs). The objective was to explore the relationship between frailty/sarcopenia and major perioperative AEs, length of stay (LOS), and unplanned reoperation following en bloc resection of primary spinal tumours. Methods: This is a unicentre study consisting of adult patients undergoing en bloc resection for a primary spine tumor. Frailty was calculated with the modified frailty index (mFI) and spine tumour frailty index (STFI). Sarcopenia was quantified with the total psoas area/vertebral body area ratio (TPA/VB) at L3 and L4. Univariable regression analysis was used to quantify the association between frailty/sarcopenia and major perioperative AEs, LOS and unplanned reoperation. Results: 95 patients met the inclusion criteria. The mFI and STFI identified a frailty prevalence of 3% and 18%. Mean CT TPA/VB ratios were 1.47 (SD ±.05) and 1.83 (SD ±.06) at L3 and L4. Inter-observer reliability was.93 and.99 for CT and MRI L3 and L4 TPA/VB ratios. Unadjusted analysis demonstrated sarcopenia and mFI did not predict perioperative AEs, LOS or unplanned reoperation. Frailty defined by an STFI score ≥2 predicted unplanned reoperation for surgical site infection (SSI) (P <.05). Conclusions: The STFI was only associated with unplanned reoperation for SSI on unadjusted analysis, while the mFI and sarcopenia were not predictive of any outcome. Further studies are needed to investigate the relationship between frailty, sarcopenia and perioperative outcomes following en bloc resection of primary spinal tumors. [ABSTRACT FROM AUTHOR]

Introduction: Following a traumatic spinal cord injury (SCI) it is critical to document the level and severity of injury. Neurological recovery occurs dynamically after injury and a baseline neurological exam offers a snapshot of the patient's impairment at that time. Understanding when this exam occurs in the recovery process is crucial for discussing prognosis and acute clinical trial enrollment. The objectives of this study were to: (1) describe the trajectory of motor recovery in persons with acute cervical SCI in the first 14 days post-injury; and (2) evaluate if the timing of the baseline neurological assessment in the first 14 days impacts the amount of motor recovery observed. Methods: Data were obtained from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) site in Vancouver and additional neurological data was extracted from medical charts. Participants with a cervical injury (Cl-Tl) who had a minimum of three exams (including a baseline and discharge exam) were included. Data on the upper-extremity motor score (UEMS), total motor score (TMS) and American Spinal Injury Association (ASIA) Impairment Scale (AIS) were included. A linear mixed-effect model with additional variables (AIS, level of injury, UEMS, time, time², and TMS) was used to explore the pattern and amount of motor recovery over time. Results: Trajectories of motor recovery in the first 14 days post-injury showed significant improvements in both TMS and UEMS for participants with AIS B, C, and D injuries, but was not different for high (CI-4) vs. low (C5-T1) cervical injuries or AIS A injuries. The timing of the baseline neurological examination significantly impacted the amount of motor recovery in participants with AIS B, C, and D injuries. Discussion: Timing of baseline neurological exams was significantly associated with the amount of motor recovery in cervical AIS B, C, and D injuries. Studies examining changes in neurological recovery should consider stratifying by severity and timing of the baseline exam to reduce bias amongst study cohorts. Future studies should validate these estimates for cervical AIS B, C, and D injuries to see if they can serve as an "adjustment factor" to control for differences in the timing of the baseline neurological exam. [ABSTRACT FROM AUTHOR]

Study Design: Ambispective cohort study. Objective: Canada has a government-funded universal health care system. The United States utilizes a multitier public and private system. The objective is to investigate differences in clinical outcomes between those surgically treated for lumbar disc herniation in a universal health care and multitier health system. Methods: Surgical lumbar disc herniation patients enrolled in the Canadian Spine Outcome Research Network (CSORN) were compared with the surgical cohort enrolled in the Spine Patients Outcome Research Trial (SPORT) study. Baseline demographics and spine-related patient-reported outcomes (PROs) were compared at 3 months and 1 year post-operatively. Results: The CSORN cohort consisted of 443 patients; the SPORT cohort had 763 patients. Patients in the CSORN cohort were older (46.4 ± 13.5 vs 41.0 ± 10.8, P <.001) and were more likely to be employed (69.5% vs 60.3%, P =.003). The CSORN cohort demonstrated significantly greater rates of satisfaction after surgery at 3 months (87.2% vs 64.8%, P <.0001) and 1 year (85.6% vs 69.6%, P <.0001). Improvements in back and leg pain followed similar trajectories in the two cohorts, but there was less improvement on ODI in the CSORN cohort (P <.01). On multivariable logistic regression, the CSORN cohort was a significant independent predictor of patient satisfaction at 1-year follow-up (P <.001). Conclusions: Despite less improvement on ODI, patients enrolled in CSORN, as part of a universal health care system, reported higher rates of satisfaction at 3 months and 1 year post-operatively compared to patients enrolled within a multitier health system. [ABSTRACT FROM AUTHOR]