Role of “Bovie” in Spinal Surgery

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Abstract
Several surgeons use electrocautery (Bovie) discreetly or avoid it completely with the fear of increasing the chances of postoperative infection and delaying wound healing. However, the experience of many other surgeons is different. The current authors have used Bovie extensively to perform a broad array of spinal surgeries. Their rate of infection in spinal surgery can be positively compared with the existing literature where Bovie has been used to variable extent. The purpose of this study is to project the authors' concept that the use of Bovie dissection in spinal surgery does not increase the chances of postoperative wound infection. A MEDLINE search was carried out to determine various aspects of Bovie, including historical perspectives, circuit design, tissue response, effect on wound healing, determination of wound infection, and role of surgical smoke. The search also included the rate of infection after various spinal surgeries in the existing literature (up to 15%). In the span of 5 years (1996-2000), 322 spinal surgeries of various kinds were performed at Children's Hospital Medical Center (Cincinnati, Ohio). Most of them were performed by the senior author (A.H.C.). There were 102 cases of idiopathic scoliosis (two infected [2%]), 53 cases of neuromuscular scoliosis (two infected [4%]), and 167 cases of other spinal surgeries (three infected [1.8%]). Of these seven patients who developed wound infection in the postoperative period, one had superficial and six had deep infection. The overall rate of wound infection was 2%. Development of infection elsewhere in the body after surgery, such as respiratory, pleural, or urinary tract infections, has not been included in this analysis. Despite the fact that the authors have extensively used Bovie in spinal surgery, their rate of postoperative wound infection is comparable with the rate of infection cited in the available literature where Bovie was used to a variable extent. It strongly suggests that the use of Bovie does not increase the chances of postoperative wound infection. The role of Bovie for musculoskeletal surgery in general and spinal surgery in particular is not well defined. A review of the available literature indicates that Bovie delays the wound healing and increases the chances of infection. The authors' experience with the Bovie and this indirect method of analysis suggest that Bovie does not increase the chances of infection. A detailed search of the literature has been presented along with historical and analytical perspectives. More clinical and experimental studies are needed to further substantiate this claim. If future publications describe the exact surgical technique, extent of the use of Bovie, infection containment (antibiotic) method used before, during, and after surgery, length of the operative exposure, duration of the surgery, and rate of infection, then a meta-analysis of the published clinical material from different centers could be performed, which would provide more comprehensive information.