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

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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).</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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 &gt; 0.7.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The NSQIP-P SSI rates, but not risk factors, were similar to data from a single center.</jats:p></jats:sec>

Epidemiology and risk factors of neurosurgical bacterial meningitis/encephalitis induced by carbapenem resistant Enterobacteriaceae

“…Several comprehensive studies have been published on the risk factors for neurosurgical meningitis [8,9], however, no study considered specific risk factors for meningitis/encephalitis caused by CRE, which prompted the need for our study. We retrospectively investigated the epidemiology of neurosurgical meningitis/encephalitis in 2012e2017 from Beijing Tiantan hospital to analysis the risk factors of CRE related meningitis/encephalitis in neurosurgical patients in order to better understand possibilities to decrease carbapenem resistance rates.…”

Unplanned readmission within 90 days after pediatric neurosurgery

“…1,7,10,13,15 Sherrod et al have demonstrated that Native American patients have a higher risk for readmission following pediatric neurosurgery. 38 We found that the children whose race was listed as "other" had higher odds of being readmitted after surgery. Given the relatively small sample size, the variables included in the model were limited; therefore, we may not have enough evidence to identify a definitive association of race with readmission.…”

“…Consistent with our findings, a number of previous studies have demonstrated that CSF-related readmissions are the most common causes of readmissions in pediatric neurosurgery. 5,11,31,38,42,46 Chern et al 11 reported a 74.5% rate of readmission in patients undergoing index surgery for shunt insertion or revision. In a recent study in which a national database for 9799 pediatric neurosurgical patients was used, Sherrod et al reported a 17.3% readmission rate associated with shunt revision.…”

Big Data Research in Pediatric Neurosurgery: Content, Statistical Output, and Bibliometric Analysis

“…Virtually all reported ESs were the result of non-hypothesis-driven exploratory analysis. Exploratory analysis is a sound method when transitioning into more focused prospective studies; however, all big data pediatric publications – except for one [29] – failed to collect and analyze data from their own institution in order to focus their efforts on using big data, or vice versa. One can easily see the subsequent challenge of translating the results of a data-driven, exploratory analysis of population-level data into one’s everyday clinical practice.…”

“…The molding of the hypothesis to fit the available data re­orders the steps of the scientific method and results in exploratory data analysis. To date, there has been only 1 study that used institutional results to drive big data research [29]. …”