UniversitätsSpital Zürich: 80 years of neurosurgical patient care in Switzerland

Stienen, Martin N.; Serra, Carlo; Stieglitz, Lennart; Krayenbühl, Niklaus; Bozinov, Oliver; Regli, Luca

doi:10.1007/s00701-017-3357-z

Cited by 17 publications

(22 citation statements)

References 80 publications

(116 reference statements)

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“…Owing to the demographic development and improvements in health care [ 8 , 11 ], the proportion of elderly cSDH patients with long-term active participation in life after burr hole trepanation is increasing. Today’s patients have evolved into informed customers and service partners, no longer expecting only the performance of a basic surgical procedure but the delivery of favorable treatment outcomes topped with an excellent service [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation—a retrospective pilot study

et al. 2018

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BackgroundThe aesthetic outcome after burr hole trepanation for the evacuation of chronic subdural hematomas (cSDH) is often unsatisfactory, as the bony skull defects may cause visible skin depressions. The purpose of this study was to evaluate the efficacy of burr hole cover placement to improve the aesthetic outcome.MethodsWe reviewed consecutive patients treated by burr hole trepanation for cSDH with or without placement of burr hole covers by a single surgeon between October 2016 and May 2018. The clinical data, including complications, were derived from the institution’s prospective patient registry. The primary endpoint was the aesthetic outcome, as perceived by patients on the aesthetic numeric analog (ANA) scale, assessed by means of a standardized telephone interview. Secondary endpoints were skin depression rates and wound pain, as well as complications.ResultsFrom n = 33, outcome evaluation was possible in n = 28 patients (n = 24 male; mean age of 70.4 ± 16.1 years) with uni- (n = 20) or bilateral cSDH (n = 8). A total of 14 burr hole covers were placed in 11 patients and compared to 50 burr holes that were not covered. Patient satisfaction with the aesthetic outcome was significantly better for covered burr holes (mean ANA 9.3 ± 0.74 vs. 7.9 ± 1.0; p < 0.001). Skin depressions occurred over 7% (n = 1/14) of covered and over 92% (n = 46/50) of uncovered burr holes (p < 0.001). There was no difference in wound pain (p = 0.903) between covered and uncovered sites. No surgical site infection, cSDH recurrence, or material failure was encountered in patients who had received a burr hole plate.ConclusionsIn this retrospective series, placement of burr hole covers was associated with improved aesthetic outcome, likely due to reduction of skin depressions. A randomized controlled trial is developed to investigate whether adding burr hole covers results in superior aesthetic outcomes, without increasing the risk for complications.

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Section: Discussionmentioning

confidence: 99%

Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation—a retrospective pilot study

et al. 2018

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“…To classify the severity of SSI complications, we used the CDG system. [3,20,24,26,29,30] Most patients with SSI required revision surgery (CDG 3a/b); only CSF-infections without placement of a foreign body and some of the superficial infections were treated conservatively without (CDG 1) or with antibiotics alone (CDG 2). Since patients with SSI were hospitalized for surgery and i.v.-antibiotic application (usually at least for 2 weeks), the data suggest -besides a high impact on the patient -high direct and indirect health-care costs associated with SSI, as well.…”

Section: Impact Of Ssimentioning

confidence: 99%

Incidence, depth, and severity of surgical site infections after neurosurgical interventions

et al. 2018

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Background Today, there are only few reports on the incidence of surgical site infections (SSIs) in neurosurgery. The objective of this work was to determine the rate of SSI at a tertiary neurosurgical department for benchmarking purpose. Methods Data of consecutive patients undergoing neurosurgical treatment between January 2013 and December 2016 were prospectively entered into a registry. SSIs were diagnosed according to the 2017 Centers for Disease Control and Prevention criteria, with severity graded according to the Clavien-Dindo grade (CDG). We analyzed type and length of surgery (LOS), time to SSI, responsible microorganisms, and its association with the functional status (Karnofsky Performance Status = KPS). Results Of n = 5463 procedures, a SSI occurred in n = 106 (1.94%). The highest rates of SSI occurred after vascular (3.4%) and cerebrospinal fluid (CSF) diversion procedures (3%), as well as after procedures performed to treat a previous complication (2.9%). There was no difference in LOS across procedures with and without SSI. The median time between the index procedure and SSI was 15.5 days. SSIs were most frequently diagnosed after hospital discharge (55%). The most common microorganisms were coagulase-negative staphylococci, Staphylococcus aureus, and Escherichia coli. In 62.3% of cases, SSI required invasive treatment (surgical revision). Patients with SSI in the in-and outpatient setting (SSI occurring after hospital discharge) presented both with a median KPS of 80. Conclusions The current report provides an overview on SSI in a contemporary, unselected, large series of patients undergoing modern neurosurgical care for benchmarking purposes. The overall rate of SSI was about 2%, but subpopulations with higher risks were identified where additional measures could be taken to prevent SSI and monitor patients at risk more closely for SSI.

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“…Nowadays, patients do not only expect the performance of a basic surgical procedure, but the delivery of favorable treatment outcomes together with excellent service. 11 We hypothesize that the awareness of skin depressions will necessarily increase among the neurosurgical community within the next years. Altogether it must be acknowledged, however, that placement of burr-hole covers is far from being a "gold standard" in today's clinical practice, considering the low rates of use and scarce literature regarding this issue.…”

Section: Awareness and Perception Of Relevancementioning

confidence: 99%

Patterns of care: burr-hole cover application for chronic subdural hematoma trepanation

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Vasella

Akeret

et al. 2019

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OBJECTIVESkin depressions may appear as undesired effects after burr-hole trepanation for the evacuation of chronic subdural hematomas (cSDH). Placement of burr-hole covers to reconstruct skull defects can prevent skin depressions, with the potential to improve the aesthetic result and patient satisfaction. The perception of the relevance of this practice, however, appears to vary substantially among neurosurgeons. The authors aimed to identify current practice variations with regard to the application of burr-hole covers after trepanation for cSDH.METHODSAn electronic survey containing 12 questions was sent to resident and faculty neurosurgeons practicing in different parts of the world, as identified by an Internet search. All responses completed between September 2018 and December 2018 were considered. Descriptive statistics and logistic regression were used to analyze the data.RESULTSA total of 604 responses were obtained, of which 576 (95.4%) provided complete data. The respondents’ mean age was 42.4 years (SD 10.5), and 86.5% were male. The sample consisted of residents, fellows, junior/senior consultants, and department chairs from 79 countries (77.4% Europe, 11.8% Asia, 5.4% America, 3.5% Africa, and 1.9% Australasia). Skin depressions were considered a relevant issue by 31.6%, and 76.0% indicated that patients complain about skin depressions more or less frequently. Burr-hole covers are placed by 28.1% in the context of cSDH evacuation more or less frequently. The most frequent reasons for not placing a burr-hole cover were the lack of proven benefit (34.8%), followed by additional costs (21.9%), technical difficulty (19.9%), and fear of increased complications (4.9%). Most respondents (77.5%) stated that they would consider placing burr-hole covers in the future if there was evidence for superiority of the practice. The use of burr-hole covers varied substantially across countries, but a country’s gross domestic product per capita was not associated with their placement.CONCLUSIONSOnly a minority of neurosurgeons place burr-hole covers after trepanation for cSDH on a regular basis, even though the majority of participants reported complaints from patients regarding postoperative skin depressions. There are significant differences in the patterns of care among countries. Class I evidence with regard to patient satisfaction and safety of burr-hole cover placement is likely to have an impact on future cSDH management.

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UniversitätsSpital Zürich: 80 years of neurosurgical patient care in Switzerland

Cited by 17 publications

References 80 publications

Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation—a retrospective pilot study

Improving the aesthetic outcome with burr hole cover placement in chronic subdural hematoma evacuation—a retrospective pilot study

Incidence, depth, and severity of surgical site infections after neurosurgical interventions

Patterns of care: burr-hole cover application for chronic subdural hematoma trepanation

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