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STUDY DESIGN: Retrospective Case-Control series. OBJECTIVE: The objective of this study is to define the overall postoperative rate of surgical site infection (SSI) in patients undergoing spine surgery and examine the effects of intrawound Vancomycin on postoperative infection rates. SUMMARY OF BACKGROUND DATA: Surgical site infections (SSI) account for 22% of all health care-associated infections. The use of intrawound Vancomycin in an attempt to reduce the incidence of postoperative SSI has not been sufficiently evaluated in the existing literature. METHODS: All spine surgeries (n=19,081) from our institution were reviewed from 2003 to 2013. All cases of verified SSI were identified from the database. Cases were then matched to controls in a 1:1 fashion based on age, gender, and date of surgery (+/-30 d). Patient demographics, comorbidities, estimated blood loss, duration of surgery, intrawound administration of Vancomycin, and smoking status were evaluated. RESULTS: At total of 316 cases of SSI after spine surgery were identified, representing an infection rate of 1.7%. The mean follow-up for cases and controls was 31.5 and 41.6 months, respectively. OR for intrawound Vancomycin was 0.44 (95% CI 0.23-0.88, P =0.019). OR for BMI greater than 30 was 1.63 (95% CI 1.04-2.56, P =0.03). CONCLUSIONS: In this large cohort of spine surgery patients, administration of intrawound Vancomycin was associated with a significant reduction in postoperative surgical site infections. Further studies are needed to determine appropriate dosing and application as well as long-term safety in spine surgery.
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Columna Vertebral , Infección de la Herida Quirúrgica , Vancomicina , Humanos , Vancomicina/uso terapéutico , Vancomicina/administración & dosificación , Infección de la Herida Quirúrgica/prevención & control , Infección de la Herida Quirúrgica/etiología , Masculino , Femenino , Estudios de Casos y Controles , Persona de Mediana Edad , Columna Vertebral/cirugía , Estudios Retrospectivos , Anciano , Adulto , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificaciónRESUMEN
INTRODUCTION: Surgical simulation is increasingly being accepted as a training platform to promote skill development and a safe surgical technique. Preliminary investigations in spine surgery show that simulation paired with educational intervention can markedly improve trainee performance. This study used a newly developed thoracolumbar fusion rod bending model to assess the effect of a novel educational curriculum and simulator training on surgical trainee rod bending speed and proficiency. METHODS: Junior (PGY1 to 2) and senior (PGY3-fellow) surgical trainees at a single academic institution were prospectively enrolled in a rod bending simulation using a T7-pelvis spinal fusion model. Participants completed two simulations, with 1 month between first and second attempts. Fifty percent of surgeons in each training level were randomized to receive an educational curriculum (rod bending technique videos and unlimited simulator practice) between simulation attempts. Rod bending simulation proficiency was determined by the percentage of participants who completed the task (conclusion at 20 minutes), time to task completion or conclusion, and number of incomplete set screws at task conclusion. Participants completed a preparticipation and postparticipation survey. Univariate analysis compared rod bending proficiency and survey results between education and control cohorts. RESULTS: Forty trainees (20 junior and 20 senior) were enrolled, with 20 participants randomized to the education and control cohorts. No notable differences were observed in the first simulation rod bending proficiency or preparticipation survey results between the education and control cohorts. In the second simulation, the education versus the control cohort demonstrated a significantly higher completion rate ( P = 0.01), shorter task time ( P = 0.009), fewer incomplete screws ( P = 0.003), and greater experience level ( P = 0.008) and comfort level ( P = 0.002) on postparticipation survey. DISCUSSION: Trainees who participated in a novel educational curriculum and simulator training relative to the control cohort improved markedly in rod bending proficiency and comfort level. Rod bending simulation could be incorporated in existing residency and fellowship surgical skills curricula. LEVEL OF EVIDENCE: I.
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Internado y Residencia , Entrenamiento Simulado , Humanos , Estudios Prospectivos , Entrenamiento Simulado/métodos , Competencia Clínica , Curriculum , Simulación por ComputadorRESUMEN
STUDY DESIGN: This was a multicenter retrospective cohort study. OBJECTIVE: The purpose of this study was to compare the surgical and radiographic outcomes of patients undergoing posterior cervical fusion (PCF) with constructs extending from C2 to T2 to patients with constructs extending from C3 to T1. SUMMARY OF BACKGROUND DATA: Limited evidence exists regarding the appropriate level of proximal and distal extension of PCF constructs. METHODS: A multicenter retrospective cohort study of patients who underwent PCF between 2012 and 2020 was performed. Surgical and radiographic outcomes were compared between those who had C3-T1 or C2-T2 constructs. RESULTS: A total of 155 patients were included in the study (C2-T2: 106 patients, C3-T1: 49 patients). There were no significant differences in demographics or preoperative symptoms between cohorts. Fusion rates were significantly higher in the C2-T2 (93%) than the C3-T1 (80%, P=0.040) cohort. When comparing the C2-T2 to the C3-T1 cohort, the C3-T1 cohort had a significantly greater rate of proximal junctional failure (2% vs. 10%, P=0.006), distal junctional failure (1% vs. 20%, P<0.001) and distal screw loosening (4% vs. 15%, P=0.02). Although ∆C2-C7 sagittal vertical axis increased significantly in both cohorts (C2-T2: 6.2 mm, P=0.04; C3-T1: 8.4 mm, P<0.001), correction did not significantly differ between groups (P=0.32). The C3-T1 cohort had a significantly greater increase in ∆C2 slope (8.0 vs. 3.1 degrees, P=0.03) and ∆C0-C2 Cobb angle (6.4 vs. 1.2 degrees, P=0.04). CONCLUSION: In patients undergoing PCF, a C2-T2 construct demonstrated lower rates of pseudarthrosis, distal junctional failure, proximal junctional failure, and compensatory upper cervical hyperextension compared with a C3-T1 construct.
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Enfermedades de la Columna Vertebral , Fusión Vertebral , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Humanos , Cuello , Estudios RetrospectivosRESUMEN
BACKGROUND: Limb-salvage surgery combined with radiotherapy has become the primary treatment for soft tissue sarcomas of the extremity. Free functional latissimus flaps (FFLF) are an option to restore function in the setting of volumetric muscle loss. The purpose of the current study was to examine the use of FFLF in patients undergoing resection of thigh sarcoma. METHODS: Twelve patients with a sarcoma involving the hamstring (n = 6), quadriceps (n = 5), or combined (n = 1) defects which included multiple muscle groups were reviewed. This included 9 males and 3 females with a mean age and body mass index of 56 ± 12 years and 31.3 ± 5.7 kg/m2. RESULTS: The mean defect volume and operative time was 3,689 ± 2,314 cm3 and 587 ± 73 minutes. Following reconstruction, the mean knee range of motion (ROM), MSTS93 score, and muscle strength was 89 ± 24°, 90 ± 15%, and 4 ± 1; with 75% of patients ambulating without gait aids. Seven (58%) patients sustained a complication, namely, delayed wound healing (n = 2). CONCLUSION: Although there was a high incidence of complications, FFLF can restore active knee ROM and function, with most patients ambulating without gait aids following reconstruction of large oncologic defects in the thigh.
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STUDY DESIGN: This was a research methodology study. OBJECTIVE: This review discusses the most commonly utilized consensus group methodologies for formulating clinical practice guidelines and current methods for accessing rigorous up-to-date clinical practice guidelines. SUMMARY OF BACKGROUND DATA: In recent years, clinical practice guidelines for the management of several conditions of the spine have emerged to provide clinicians with evidence-based best-practices. Many of these guidelines are used routinely by administrators, payers, and providers to determine the high-quality and cost-effective surgical practices. Most of these guidelines are formulated by consensus groups, which employ methodologies that are unfamiliar to most clinicians. METHODS: An extensive literature review was performed. The literature was then summarized in accordance with the authors' clinical experience. RESULTS: The Nominal Group Technique, Delphi method, and RAND-UCLA Appropriateness Model are 3 commonly utilized consensus group methodologies employed in the creation of clinical practice guidelines. Each of these methodologies has inherent advantages and disadvantages, is dependent on rigorously performed systematic reviews and meta-analyses to inform the panel of experts, and can be used to answer challenging clinical questions that remain unanswered due to a paucity of class I evidence. CONCLUSIONS: This review highlights the most commonly utilized consensus group methodologies and informs spine surgeons regarding options to access current clinical practice guidelines. LEVEL OF EVIDENCE: Level V.
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Columna Vertebral , Cirujanos , Consenso , Humanos , Proyectos de Investigación , Columna Vertebral/cirugíaRESUMEN
BACKGROUND: Foot and ankle soft tissue sarcomas (STS) are challenging for reconstruction due to limited surrounding soft tissue and weight-bearing requirements. Currently, there is a paucity of data examining the outcome of flap reconstruction following resection of a foot and ankle sarcoma. METHODS: We reviewed 44 (31 female, 13 male) patients with STS arising from the ankle or foot which required coverage in the form of a free (n = 21), pedicled (n = 13), or rotational perforator flap (n = 10). The mean tumor size was 6 ± 5 cm, with 39 (89%) patients receiving radiotherapy. The mean follow-up was 10 ± 7 years. RESULTS: There were no cases of amputation due to flap failure, with a 10-year limb salvage rate of 84%. Complications occurred in 19 (43%) patients, most commonly wound infections. There was no difference in the incidence of complications between patients undergoing a free flap and pedicled or perforator flap (odds ratio = 0.97, p = 1.0); with no difference in the mean Musculoskeletal Tumor Society (MSTS) score between patients with a free flap versus a pedicled/perforator flap (84% vs. 76%, p = 0.11). CONCLUSION: Flap reconstruction is an essential part of limb salvage for foot and ankle STS. At final follow-up nearly all the patients are ambulatory with an acceptable MSTS score.
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Tobillo/cirugía , Pie/cirugía , Colgajos Tisulares Libres , Colgajo Perforante , Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/cirugía , Amputación Quirúrgica , Femenino , Estudios de Seguimiento , Humanos , Recuperación del Miembro , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Complicaciones Posoperatorias , Radioterapia Adyuvante , Estudios Retrospectivos , Sarcoma/radioterapia , Neoplasias de los Tejidos Blandos/radioterapiaAsunto(s)
Enfermedades del Pie/cirugía , Melanoma/cirugía , Neoplasias Cutáneas/cirugía , Colgajos Quirúrgicos/cirugía , Dedos del Pie/cirugía , Femenino , Pie/patología , Pie/cirugía , Enfermedades del Pie/patología , Humanos , Masculino , Melanoma/patología , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Neoplasias Cutáneas/patologíaRESUMEN
BACKGROUND/AIM: Reconstruction for soft-tissue sarcomas is complex and often uses soft-tissue flaps. To preserve critical structures, intraoperative radiotherapy (IORT) can be used to boost the total dose to these critical structures and close margins; however, there are limited data on the outcome of soft-tissue reconstruction in patients treated with IORT. PATIENTS AND METHODS: Twenty patients received IORT with soft-tissue flap coverage. There were 14 tumors of the lower extremities and six of the upper, including seven free-flaps and 13 pedicle flaps. Mean preoperative and IORT doses were 49.4 Gy and 10.4 Gy, respectively, with a mean total dose of 59.8 Gy. RESULTS: Seven (35%) patients had a complication, most commonly an infection (n=4, 27%). Total flap loss occurred in one treated with pedicle flap. Four (20%) patients suffered a radiation-associated fracture. At the final follow-up, the mean Musculoskeletal Tumor Society Score was 75±11%. CONCLUSION: Complications and postoperative fractures were common with IORT, however, there were no cases requiring amputation.
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Extremidades/patología , Extremidades/cirugía , Procedimientos de Cirugía Plástica , Neoplasias de los Tejidos Blandos/terapia , Adulto , Anciano , Terapia Combinada , Femenino , Humanos , Cuidados Intraoperatorios , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Cuidados Preoperatorios , Radioterapia Adyuvante , Recurrencia , Neoplasias de los Tejidos Blandos/diagnóstico , Resultado del TratamientoRESUMEN
Telehealth has been used for decades to improve access to care for rural and underserved patients. The adoption of telehealth in orthopedic oncology is novel and expected to positively impact patient access and compliance. However, no previous evaluation has been published of this expected impact. The objective of this pilot project was to evaluate patients' perceptions regarding orthopedic oncology telehealth services. A 13-question satisfaction survey was distributed to patients who used tele-orthopedic oncology. Fifteen respondents (a response rate of 42%) reported satisfaction with services at 9.7 of 10. Median travel distance to the nearest in-person orthopedic oncologist was greater than 150 miles (241 km). These results are consistent with the previous findings of high satisfaction with telehealth in other specialties. Health care organizations are likely to benefit from offering telehealth to orthopedic oncology patients with limited access.
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Interfacial polymerization is widely used today for the production of ultrathin films for encapsulation, chemical separations, and desalination. Polyamide films, in particular, are employed in manufacturing of reverse osmosis and nanofiltration membranes. While these materials show excellent salt rejection, they have rather low water permeability, both properties that apparently stem from the rigid cross-linked structure. An increasing amount of experimental research on membranes of different chemistries and membrane characterization suggests the importance of other factors (such as unreacted functional groups and surface roughness) in determining membrane performance. We developed a molecular simulation model to qualitatively study the effects of various synthesis conditions on membrane performance, in terms of its estimated porosity and permeability. The model is of an interfacial aggregation process of two types of functional monomers. Film growth with time and structural characteristics of the final film are compared with predictions of existing theories and experimental observations.