Use of an Operating Microscope During Spine Surgery Is Associated With Minor Increases in Operating Room Times and No Increased Risk of Infection

Study Design. Retrospective database review. Objective. To evaluate whether microscope use during spine procedures is associated with increased operating room times or increased risk of infection. Summary of Background Data. 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. Conclusion. We did not find operating room times or infection risk to be significant deterrents for use of an operating microscope during spine surgery.