Risk Factors for Craniotomy or Spinal Fusion Surgical Site Infection

Elward, Alexis; Yegge, Jeanne; Recktenwald, Angela; Jadwisiak, Louise; Kieffer, Patricia; Hohrein, Melinda; Hopkins-Broyles, Diane; Woeltje, Keith F.

doi:10.1097/inf.0000000000000889

Cited by 14 publications

(6 citation statements)

References 9 publications

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“…Implementation of infection prevention protocols has significantly decreased rates of infection in shunt and spine surgery, 16,17,36,40,41 demonstrating room for quality improvement and potential application of similar protocols in general neurosurgical nonshunt surgery. While previous studies have demonstrated reduced SSI rates with interventions such as antibiotic-impregnated sutures, 40 double gloving, 47 administration of intraoperative bacitracin or vancomycin powder prior to wound closure, 1,8,9 and appropriately dosing antibiotics and minimizing hypothermia, 15 none of these factors were significantly associated with SSI in either the NSQIP-P or institutional analysis. In fact, no modifiable risk factors were identified in either analysis.…”

Section: Discussionmentioning

confidence: 72%

Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience

Sherrod

Arynchyna

Johnston

et al. 2017

PED

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OBJECTIVE Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional data set specifically for better understanding SSI. METHODS The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program–Pediatric (ACS NSQIP-P) database for the years 2012–2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations. SSI included deep (intracranial abscesses, meningitis, osteomyelitis, and ventriculitis) and superficial wound infections. The authors performed univariate analyses of SSI association with procedure, demographic, comorbidity, operative, and hospital variables, with subsequent multivariate logistic regression analysis to determine independent risk factors for SSI within 30 days of the index procedure. A similar analysis was performed using a detailed institutional infection database from Children's of Alabama (COA). RESULTS A total of 9296 nonshunt procedures were identified in NSQIP-P with an overall 30-day SSI rate of 2.7%. The 30-day SSI rate in the COA institutional database was similar (3.3% of 1103 procedures, p = 0.325). Postoperative time to SSI in NSQIP-P and COA was 14.6 ± 6.8 days and 14.8 ± 7.3 days, respectively (mean ± SD). Myelomeningocele (4.3% in NSQIP-P, 6.3% in COA), spine (3.5%, 4.9%), and epilepsy (3.4%, 3.1%) procedure categories had the highest SSI rates by procedure category in both NSQIP-P and COA. Independent SSI risk factors in NSQIP-P included postoperative pneumonia (OR 4.761, 95% CI 1.269–17.857, p = 0.021), immune disease/immunosuppressant use (OR 3.671, 95% CI 1.371–9.827, p = 0.010), cerebral palsy (OR 2.835, 95% CI 1.463–5.494, p = 0.002), emergency operation (OR 1.843, 95% CI 1.011–3.360, p = 0.046), spine procedures (OR 1.673, 95% CI 1.036–2.702, p = 0.035), acquired CNS abnormality (OR 1.620, 95% CI 1.085–2.420, p = 0.018), and female sex (OR 1.475, 95% CI 1.062–2.049, p = 0.021). The only COA factor independently associated with SSI in the COA database included clean-contaminated wound classification (OR 3.887, 95% CI 1.354–11.153, p = 0.012), with public insurance (OR 1.966, 95% CI 0.957–4.041, p = 0.066) and spine procedures (OR 1.982, 95% CI 0.955–4.114, p = 0.066) approaching significance. Both NSQIP-P and COA multivariate model C-statistics were > 0.7. CONCLUSIONS The NSQIP-P SSI rates, but not risk factors, were similar to data from a single center.

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Section: Discussionmentioning

confidence: 72%

Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience

Sherrod

Arynchyna

Johnston

et al. 2017

PED

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“…As mentioned before, the type of surgery the patient undergoes greatly influences the risk of SSIs, and many studies have investigated the incidence of SSIs in specific subcategories of surgery. Elward and colleagues identified risk factors for SSIs in neurosurgical pediatric patients who underwent craniotomy or spinal fusion [ 21 ]. With regard to craniotomy, a longer time in the operating room, a longer procedure and previous craniotomy were significant risk factors for SSIs.…”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

“…With regard to craniotomy, a longer time in the operating room, a longer procedure and previous craniotomy were significant risk factors for SSIs. In the cohort of patients who were treated with spinal fusion, longer time at the lowest body temperature and use of anticoagulants post-operatively were significantly associated with SSIs [ 21 ].…”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

“…Overall, the available literature showed that SSIs are a frequent event in children, leading to relevant complications and prolonged hospital stays [ 30 , 31 ]. Table 1 summarize SSI rates in pediatric and neonatal studies [ 17 , 18 , 19 , 20 , 22 , 23 , 25 , 26 , 27 , 29 , 30 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ], whereas Table 2 summarize the main risk factors for SSI [ 17 , 20 , 21 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ].…”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

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Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention

et al. 2022

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A surgical site infection (SSI) is an infection that occurs in the incision created by an invasive surgical procedure. Although most infections are treatable with antibiotics, SSIs remain a significant cause of morbidity and mortality after surgery and have a significant economic impact on health systems. Preventive measures are essential to decrease the incidence of SSIs and antibiotic abuse, but data in the literature regarding risk factors for SSIs in the pediatric age group are scarce, and current guidelines for the prevention of the risk of developing SSIs are mainly focused on the adult population. This document describes the current knowledge on risk factors for SSIs in neonates and children undergoing surgery and has the purpose of providing guidance to health care professionals for the prevention of SSIs in this population. Our aim is to consider the possible non-pharmacological measures that can be adopted to prevent SSIs. To our knowledge, this is the first study to provide recommendations based on a careful review of the available scientific evidence for the non-pharmacological prevention of SSIs in neonates and children. The specific scenarios developed are intended to guide the healthcare professional in practice to ensure standardized management of the neonatal and pediatric patients, decrease the incidence of SSIs and reduce antibiotic abuse.

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“…14,15,28,29 However, few studies have investigated SSI or SSI-associated morbidity and mortality following nonshunt neurosurgical procedures. Although several studies have investigated SSI rates after nonshunt pediatric neurosurgery at single centers, 9,10,20,24,32,35 no studies have investigated multicenter nonshunt SSI outcomes. Due to potential variation in SSI rates by center and/or surgeon, analysis of multicenter data on SSI and its associated morbidity is needed.…”

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confidence: 99%

Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery

Sherrod¹,

Rocque²

2017

PED

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OBJECTIVE Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. METHODS The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program–Pediatric (NSQIP-P) 2012–2014 database, including all neurosurgical procedures performed on pediatric patients. Procedures were categorized by Current Procedural Terminology (CPT) codes. CSF shunts were excluded. Deep and superficial SSIs occurring within 30 days of an index procedure were identified. Deep SSIs included deep wound infections, intracranial abscesses, meningitis, osteomyelitis, and ventriculitis. The following outcomes occurring within 30 days of an index procedure were analyzed, along with postoperative time to complication development: sepsis, wound disruption, length of postoperative stay, readmission, reoperation, and death. RESULTS A total of 251 procedures associated with a 30-day SSI were identified (2.7% of 9296 procedures). Superficial SSIs were more common than deep SSIs (57.4% versus 42.6%). Deep SSIs occurred more frequently after epilepsy or intracranial tumor procedures. Superficial SSIs occurred more frequently after skin lesion, spine, Chiari decompression, craniofacial, and myelomeningocele closure procedures. The mean (± SD) postoperative length of stay for patients with any SSI was 9.6 ± 14.8 days (median 4 days). Post-SSI outcomes significantly associated with previous SSI included wound disruption (12.4%), sepsis (15.5%), readmission (36.7%), and reoperation (43.4%) (p < 0.001 for each). Post-SSI sepsis rates (6.3% vs 28.0% for superficial versus deep SSI, respectively; p < 0.001), wound disruption rates (4.9% vs 22.4%, p < 0.001), and reoperation rates (23.6% vs 70.1%, p < 0.001) were significantly greater for patients with deep SSIs. Postoperative length of stay in patients discharged before SSI development was not significantly different for deep versus superficial SSI (4.2 ± 2.7 vs 3.6 ± 2.4 days, p = 0.094). No patient with SSI died within 30 days after surgery. CONCLUSIONS Thirty-day SSI is associated with significant 30-day morbidity in pediatric patients undergoing nonshunt neurosurgery. Rates of SSI-associated complications are significantly lower in patients with superficial infection than in those with deep infection. There were no cases of SSI-related mortality within 30 days of the index procedure.

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Risk Factors for Craniotomy or Spinal Fusion Surgical Site Infection

Cited by 14 publications

References 9 publications

Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience

Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience

Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention

Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery

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