title: Use of an operating microscope during spine surgery is associated with minor increases in operating room times and no increased risk of infection.
abstract: METHODS
  Retrospective database review.
  
  
  OBJECTIVE
  To evaluate whether microscope use during spine procedures is associated with increased operating room times or increased risk of infection.
  
  
  BACKGROUND
  Operating microscopes are commonly used in spine procedures. It is debated whether the use of an operating microscope increases operating room time or confers increased risk of infection.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program database, which includes data from more than 370 participating hospitals, was used to identify patients undergoing elective spinal procedures with and without the use of an operating microscope for the years 2011 and 2012. Bivariate and multivariate linear regressions were used to test the association between microscope use and operating room times. Bivariate and multivariate logistic regressions were similarly conducted to test the association between microscope use and infection occurrence within 30 days of surgery.
  
  
  RESULTS
  A total of 23,670 elective spine procedures were identified, of which 2226 (9.4%) used an operating microscope. The average patient age was 55.1±14.4 years. The average operative time (incision to closure) was 125.7±82.0 minutes.Microscope use was associated with minor increases in preoperative room time (+2.9 min, P=0.013), operative time (+13.2 min, P<0.001), and total room time (+18.6 min, P<0.001) on multivariate analysis.A total of 328 (1.4%) patients had an infection within 30 days of surgery. Multivariate analysis revealed no significant difference between the microscope and nonmicroscope groups for occurrence of any infection, superficial surgical site infection, deep surgical site infection, organ space infection, or sepsis/septic shock, regardless of surgery type.
  
  
  CONCLUSIONS
  We did not find operating room times or infection risk to be significant deterrents for use of an operating microscope during spine surgery.
  
  
  METHODS
  3.
authors.affiliation: From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
authors.forename: Bryce A
authors.initials: BA
authors.lastname: Basques
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Golinvaux
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.forename: Alem
authors.initials: A
authors.lastname: Yacob
authors.forename: Jason O
authors.initials: JO
authors.lastname: Toy
authors.forename: Arya G
authors.initials: AG
authors.lastname: Varthi
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D009873:Operating Rooms / Q000706:statistics & numerical data*; D061646:Operative Time; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology*; D013131:Spine / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology*; D013997:Time Factors; D014481:United States / Q000453:epidemiology