Risk factors for surgical site infections in neurosurgery

Area of Science:

• Neurosurgery
• Infectious Disease Epidemiology
• Surgical Outcomes Research

Background:

• Surgical site infections (SSIs) pose significant risks in neurosurgery, contributing to high morbidity and mortality rates.
• Limited public data exists on the incidence and risk factors of SSIs specifically within neurosurgical patient cohorts.
• Understanding SSI rates is crucial for improving patient outcomes and healthcare standards in neurosurgical departments.

Purpose of the Study:

• To determine the incidence of SSIs requiring reoperation in a large neurosurgical cohort over a seven-year period.
• To identify statistically significant risk factors associated with the development of SSIs necessitating reoperation.
• To provide data supporting enhanced monitoring and risk factor mitigation strategies for neurosurgical SSIs.

Main Methods:

• A retrospective analysis of 16,513 neurosurgical patients over seven years at a single institution.
• Identification of patients requiring reoperation for suspected SSIs, with exclusions for intraoperative absence of infection or primary infections.
• Review of clinical notes to identify and analyze potential risk factors, including wound leak, medication use, instrumentation, and operative duration.

Main Results:

• 1.20% of the studied neurosurgical patients required at least one reoperation to treat a SSI.
• Statistically significant risk factors for SSI reoperation included wound leak (OR: 27.41), dexamethasone use (OR: 3.55), instrumentation (OR: 2.74), and operative duration exceeding 180 minutes (OR: 1.85).
• These findings highlight specific factors that increase the likelihood of SSIs requiring surgical intervention.

Conclusions:

• This study presents the first UK-based, long-term analysis of SSI reoperation rates in a substantial neurosurgical cohort.
• Identifying and monitoring risk factors such as wound leak, steroid use, instrumentation, and prolonged surgery is essential for preventing SSIs.
• Implementing robust auditing, departmental registers, and public reporting of SSIs can improve healthcare standards and allow for proactive risk management.