Surgical Site Infection After Autologous Cranioplasty for Decompressive Craniectomy in Traumatic Brain Injury: A Retrospective Review of Two Level 1 Trauma Centers

Abstract

Object: Surgical site infection (SSI) after cranioplasty can result in unnecessary morbidity. This analysis was designed to determine the risk factors of SSI after cranioplasty in patients who received a decompressive craniectomy with the autologous bone for traumatic brain injury (TBI). Methods: A retrospective review was performed at two level 1 academic trauma centers for adult patients who underwent autologous cranioplasty after prior decompressive craniectomy for TBI. Demographic and procedural variables were collected and analyzed for associations with an increased incidence of surgical site infection with two-sample independent t tests and Mann Whitney U tests, and with a Bonferroni correction applied in cases of multiple comparisons. Statistical significance was reported with a P value of < 0.05. Results: A total of 71 patients were identified. The mean interval from craniectomy to cranioplasty was 99 days (7-283), and 3 patients developed SSIs after cranioplasty (4.2%). Postoperative drain placement (P > 0.08) and administration of intrawound vancomycin powder (P ¼ 0.99) were not predictive of infection risk. However, a trend was observed suggesting that administration of prophylactic preoperative IV vancomycin is associated with a reduced infection rate. Conclusions: The SSI rate after autologous cranioplasty in TBI patients is lower than previously reported for heterogeneous groups and indications, and the infection risk is comparable to other elective neurosurgical procedures. As such, the authors recommend attempting to preserve native skull and perform autologous cranioplasty in this population whenever possible.

Postoperative infection after cranioplasty in traumatic brain injury: a single center experience

“…Diabetes has been associated with various postoperative morbidity, including postoperative infection after cranioplasty [3,4,6]. In this study, we also found a strong correlation between diabetes and infection.…”

“…However, cranioplasties can have serious complications including infection, seizures, bone resorption, and delayed hydrocephalus [3] with an overall complication rate reported as high as 40% [4]. Among these complications, postoperative infection is one of the most important complications because it can lead to serious conditions including empyema and meningitis, that require a long period of intravenous antibiotics treatment and possibly multiple surgeries.…”

“…Several studies have identified factors associated with infection after cranioplasty [3][4][5][6], mostly with heterogenous etiology and autologous bone graft. However, despite the recent development and increased usage of new graft materials, few attempts have been made to investigate infection risk of these newer material.…”

Treatment of Ventriculitis and Meningitis After Neurosurgery Caused by Carbapenem-Resistant Enterobacteriaceae (CRE): A Challenging Topic

“… Maye et al 40 267 4.5% – NS: Intraoperative monitoring and 5-ALA f Only for neuro-oncology surgery. Caruso et al 41 71 4.2% – NS: Postoperative drain placement; Administration of intrawound vancomycin powder; Prophylactic preoperative IV vancomycin is a protective factor; For autologous cranioplasty after decompressive craniectomy in TBI g . Alkhaibary et al 42 103 15.7% Blood glucose levels Skull defect size For Autologous Cranioplasty Valentini et al 43 6359 1.7% Younger patients (≤14 years) The number of surgeries Surgeries lasting longer than 3 hours Two or more surgeries with prosthetic implants ABP prolongation showed limited efficacy for wound complication.…”

Risk assessment and pathogen profile of surgical site infections in traumatic brain injury patients undergoing emergency craniotomy: A retrospective study

“…The duration and complexity of the surgery also contribute to this heightened risk. Moreover, the variability in the type of pathogens responsible for SSIs, influenced by factors like the hospital environment, antibiotic resistance patterns, and individual patient microbiota, adds another layer of complexity to managing these infections 19 …”