The effect of a surgical smoke evacuation system on surgical site infections of the spine

Objectives: To review the literature on surgical smoke and to study the effect of a smoke evacuation system on the rate of surgical site infections (SSIs) after spine surgery.Introduction: Surgical site infections continue to represent a costly complication of spine surgery.Studies show that surgical smoke can contain infectious agents, and smoke evacuation systems have demonstrated effective removal of these particles from the operative field.Methods: This study was a retrospective cohort analysis of surgical cases performed at two high-volume medical centers by three surgeons.Demographic and perioperative data were prospectively collected using the Spine AdVerse Events Severity (SAVES) system.The surgical invasiveness index and Charlson comorbidity score were calculated for each case.The incidence of SSIs in a cohort of surgical cases involving a smoke evacuator device was compared to a cohort that excluded the device.Statistical analyses were conducted to assess the relationship between patient and surgery characteristics and the wound infection outcome in relation to use of a surgical smoke evacuation system.Results: 1312 spine surgery cases were included in the study.Of the 712 cases in the control group, 24 SSIs occurred (11 deep, 13 superficial), for an overall incidence of 3.4%.Of the 600 cases in the smoke evacuator group, 12 SSIs occurred (8 deep, 4 superficial), for an overall incidence of 2%.The observed difference in SSI incidence was not statistically significant (p = 0.17).The odds ratio for developing SSI calculated for the smoke evacuator group compared to the control group was 0.56 (95% CI 0.28-1.14).Discussion: This study represents an important first attempt at characterizing a previously unidentified, modifiable risk factor to consider in future studies of infection rates after spine surgery.