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Purpose of Review The COVID-19 pandemic has had a profound impact on athletics, and the question of safely resuming competitive sports at all levels has been a source of significant debate. Concerns regarding myocarditis and the risk of arrhythmias and sudden death in athletes have prompted heightened attention to the role of cardiovascular screening. In this review, we aim to comprehensively outline the cardiovascular manifestations associated with COVID-19 infection, to discuss screening, diagnosis, and treatment strategies, and to evaluate the current literature on the risk to athletes and recommendations regarding return-to-play. Recent Findings COVID-19 is known to cause myocarditis, with presentations ranging from subclinical current or prior infection detected on cardiac MRI imaging, to fulminant heart failure and shock. While initial data early in the pandemic suggested that the risk of myocarditis could be significant even in patients with nonsevere COVID-19 infection, recent studies suggest a very low prevalence of clinically significant disease in young athletes. Summary While COVID-19 can have significant cardiovascular manifestations, recent data demonstrate that a screening approach guided by severity of COVID-19 infection and cardiovascular symptoms allows the majority of athletes to safely return to play in a timely manner. We must continue to tailor our approach to screening athletes as knowledge grows, and further research on the longitudinal cardiovascular effects of COVID-19 is needed.

OBJECTIVEVenous thromboembolic events (VTEs) are a common cause of morbidity and mortality after spine surgery. Patients admitted to the intensive care unit (ICU) following spine surgery exhibit high-risk clinical characteristics.METHODSThe authors retrospectively analyzed 1269 ICU patients who had undergone spine surgery between January 1, 2009, and May 31, 2015. Relevant demographic, procedural, and outcome variables were collected.RESULTSPatients admitted to the ICU postoperatively had a postoperative VTE rate of 10.2%, compared to 2.5% among all spine surgery patients during the study period. ICU patients had a higher comorbid disease burden (odds ratio [OR] 1.45, p < 0.001), and were more likely to have a history of a bleeding disorder (2.60% vs 0.46%, OR 2.85, p = 0.028), receive a transfusion (OR 4.81, p < 0.001), have a fracture repaired (OR 4.30, p < 0.001), have an estimated blood loss > 500 ml (OR 1.95, p = 0.009), have an osteotomy (OR 20.47, p = 0.006), or have a corpectomy (OR 3.48, p = 0.007) than patients not admitted to the ICU. There was a significant difference in time to VTE between patients undergoing osteotomy and patients undergoing scoliosis corrections without osteotomy (p = 0.0431), patients with fractures (p = 0.0113), and patients undergoing fusions for indications other than scoliosis or fracture (p = 0.0056). Patients who developed a deep vein thrombosis (DVT) during their ICU stay were more likely to have received a prophylactic inferior vena cava filter placement (OR 8.98, p < 0.001), have undergone an interbody fusion procedure (OR 2.38, p = 0.037), have a history of DVT (OR 3.25, p < 0.001), and have shorter surgery times (OR 0.30, p = 0.002). Patients who developed a pulmonary embolism (PE) during the ICU stay were more likely to have a history of PE (OR 12.68 p = 0.015), history of DVT (OR 5.11, p = 0.042), fracture diagnosis (OR 7.02, p = 0.040), and diagnosis of scoliosis (OR 7.78, p = 0.024). Patients with higher BMIs (OR 0.85, p = 0.036) and those who received anticoagulation treatment (OR 0.16, p = 0.031) were less likely to develop a PE during their ICU stay.CONCLUSIONSPatients admitted to the ICU following spine surgery have a higher rate of VTE than non-ICU patients. Time to VTE varied by pathology. Factors independently associated with VTE in the ICU are distinct from factors otherwise associated with VTE. Some factors are independently associated with VTE throughout the 30-day postoperative period, while others are associated with VTE specifically during the initial ICU stay or after leaving the ICU.

Study Design. Retrospective case series. Objective. We sought to identify risk factors associated with surgical site infection (SSI) after posterior long segment spinal fusion (PLSF). Summary of Background Data. Patients who undergo PLSF may be at elevated risk of SSI. Identifying factors associated with SSI in these operations can help risk stratify patients and tailor management. Methods. We analyzed PLSFs-seven or more levels-at our institution from 2000 to 2015. Data on patients' clinical characteristics, procedural factors, and antimicrobial management were collected. Multivariable analysis identified factors independently associated with outcomes of interest. Results. In 628 cases, SSI was associated with steroid use (P ¼ 0.024, odds ratio [OR] ¼ 2.54) and using cefazolin (P < 0.001, OR ¼ 4.37) or bacitracin (P ¼ 0.010, OR 3.49) irrigation, as opposed to gentamicin or other irrigation. Gram-positive infections were more likely with staged procedures (P ¼ 0.021, OR 4.91) and bacitracin irrigation (P < 0.001, OR ¼ 17.98), and less likely with vancomycin powder (P ¼ 0.050, OR 0.20). Gram-negative infections were more likely with a history of peripheral arterial disease (P ¼ 0.034, OR ¼ 3.21) or cefazolin irrigation (P < 0.001, OR 25.47). Readmission was more likely after staged procedures (P ¼ 0.003, OR ¼ 3.31), cervical spine surgery (P ¼ 0.023, OR ¼ 2.28), or cefazolin irrigation (P ¼ 0.039, OR ¼ 1.85). Reoperation was more common with more comor-bidities (P ¼ 0.022, OR 1.09), staged procedures (P < 0.001, OR ¼ 4.72), cervical surgeries (P ¼ 0.013, OR ¼ 2.36), more participants in the surgery (P ¼ 0.011, OR ¼ 1.06), using cefazolin (P < 0.001, OR ¼ 3.12) or bacitracin (P ¼ 0.009, OR ¼ 3.15) irrigation, and higher erythrocyte sedimentation rate at readmission (P ¼ 0.009, OR ¼ 1.04). Washouts were more likely among patients with more comorbidities (P ¼ 0.013, OR ¼ 1.16), or who used steroids (P ¼ 0.022, OR ¼ 2.92), and less likely after cervical surgery (P ¼ 0.028, OR ¼ 0.24). Instrumentation removal was more common with bacitracin irrigation (p ¼ 0.013, OR ¼ 31.76). Conclusion. Patient factors, whether a procedure is staged, and choice of antibiotic irrigation affect the risk of SSI and ensuing management required.

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Objective Recently, minimally invasive surgery (MIS) has been included among the treatment modalities for scoliosis. However, literature comparing MIS to open surgery for scoliosis correction is limited. The objective of this study was to compare outcomes for scoliosis correction patients undergoing MIS versus open approach. Methods We retrospectively collected data on demographics, procedure characteristics, and outcomes for 207 consecutive scoliosis correction surgeries at our institution between 2009 and 2015. Results MIS patients had lower number of levels fused (p < 0.0001), shorter surgeries (p = 0.0023), and shorter overall lengths of stay (p < 0.0001), were less likely to be admitted to the ICU (p < 0.0001), and had shorter ICU stays (p = 0.0015). On multivariable regression, number of levels fused predicted selection for MIS procedure (p = 0.004), and multiple other variables showed trends toward significance. Age predicted ICU admission and VTE. BMI predicted any VTE, and DVT specifically. Comorbid disease burden predicted readmission, need for transfusion, and ICU admission. Number of levels fused predicted prolonged surgery, need for transfusion, and ICU admission. Conclusions Patients undergoing MIS correction had shorter surgeries, shorter lengths of stay, and shorter and fewer ICU stays, but there was a significant selection effect. Accounting for other variables, MIS did not independently predict any of the outcomes.

BACKGROUND:Most posterior spinal fusion (PSF) patients do not require admission to an intensive care unit (ICU), and those who do may represent an underinvestigated, high-risk subpopulation.OBJECTIVE:To identify the microbial profile of and risk factors for surgical site infection (SSI) in PSF patients admitted to the ICU postoperatively.METHODS:We examined 3965 consecutive PSF patients treated at our institution between 2000 and 2015 and collected demographic, clinical, and procedural data. Comorbid disease burden was quantified using the Charlson Comorbidity Index (CCI). We performed multivariable logistic regression to identify risk factors for SSI, readmission, and reoperation.RESULTS:Anemia, more levels fused, cervical surgery, and cerebrospinal fluid leak were positively associated with ICU admission, and minimally invasive surgery was negatively associated. The median time to infection was equivalent for ICU patients and non-ICU patients, and microbial culture results were similar between groups. Higher CCI and undergoing a staged procedure were associated with readmission, reoperation, and SSI. When stratified by CCI into quintiles, SSI rates show a strong linear correlation with CCI (P = .0171, R = 0.941), with a 3-fold higher odds of SSI in the highest risk group than the lowest (odds ratio = 3.15 [1.19, 8.07], P = .032).CONCLUSION:Procedural characteristics drive the decision to admit to the ICU postoperatively. Patients admitted to the ICU have higher rates of SSI but no difference in the timing of or microorganisms that lead to those infections. Comorbid disease burden drives SSI in this population, with a 3-fold greater odds of SSI for high-risk patients than low-risk patients.

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