Risk factors for surgical site infection after craniotomy: a prospective cohort study

Abstract

Background Although surgical site infection after craniotomy (SSI-CRAN) is a serious complication, risk factors for its development have not been well defined. We aim to identify the risk factors for developing SSI-CRAN in a large prospective cohort of adult patients undergoing craniotomy. Methods A series of consecutive patients who underwent craniotomy at a university hospital from January 2013 to December 2015 were prospectively assessed. Demographic, epidemiological, surgical, clinical and microbiological data were collected. Patients were followed up in an active post-discharge surveillance programm e for up to one year after surgery. Multivariate analysis was carried out to identify independent risk factors for SSI-CRAN. Results Among the 595 patients who underwent craniotomy, 91 (15.3%) episodes of SSI-CRAN were recorded, 67 (73.6%) of which were organ/space. Baseline demographic characteristics were similar among patients who developed SSI-CRAN and those who did not. The most frequent causative Gram-positive organisms were Cutibacterium acnes (23.1%) and Staphylococcus epidermidis (23.1%), whereas Enterobacter cloacae (12.1%) was the most commonly isolated Gram-negative agent. In the univariate analysis the factors associated with SSI-CRAN were ASA score > 2 (48.4% vs. 35.5% in SSI-CRAN and no SSI-CRAN respectively, p = 0.025), extrinsic tumour (28.6% vs. 19.2%, p = 0.05), and re-intervention (4.4% vs. 1.4%, p = < 0.001). In the multivariate analysis, ASA score > 2 (AOR: 2.26, 95% CI: 1.32–3.87; p = .003) and re-intervention (OR: 8.93, 95% CI: 5.33–14.96; p < 0.001) were the only factors independently associated with SSI-CRAN. Conclusion The risk factors and causative agents of SSI-CRAN identified in this study should be considered in the design of preventive strategies aimed to reduce the incidence of this serious complication. Electronic supplementary material The online version of this article (10.1186/s13756-019-0525-3) contains supplementary material, which is available to authorized users.

Impact of preoperative Karnofsky Performance Scale (KPS) and American Society of Anesthesiologists (ASA) scores on perioperative complications in patients with recurrent glioma undergoing repeated operation

“…Reponen et al reported that high ASA scores are associated with increased systemic and infectious complications [17]. A more recent study has confirmed that high ASA scores are one of the independent risk factors for surgical site infection after craniotomy [18]. In the present study, the rate of systemic infections was higher in the high ASA than in the low ASA group, but the difference was not significant.…”

“…Increased postsurgical complications in patients with glioma with low KPS have been reported by several groups [4,[9][10][11]. In addition, the American Society of Anesthesiologists (ASA) score, which is a widely used clinical preoperative physical status classification, is a well-known risk factor for preoperative mortality and complications after craniotomy in patients with various brain tumors [12][13][14][15][16][17][18]. However, little is known about the impact of KPS and ASA scores in patients who undergo craniotomy for recurrent glioma.…”

Recurrence and Coniglobus Volumetric Resolution of Subacute and Chronic Subdural Hematoma Post-Middle Meningeal Artery Embolization

“…The agent most commonly used for embolization has been 150-250 µm polyvinyl alcohol particles [14,19,36]. Some operators have also used 15-20% n-butyl-2-cyanoacrylate (NBCA) particles [8].…”

Development and validation of prediction scores for nosocomial infections, reoperations, and adverse events in the daily clinical setting of neurosurgical patients with cerebral and spinal tumors

“…[27][28][29] Similarly, nosocomial infection rates (7.4%) and surgical site infection rates (1.8%) were lower when compared with other published results. 30,31 The occurrence of any adverse event (14.5%) appears to be low; however, it is challenging to appropriately compare, as it is highly dependent on which events are included in this cumulative variable.…”