Frontofacial Surgery: Reducing Infection with the Development and 6-Year Outcome of a Frontofacial Protocol.

Area of Science:

• Neurosurgery
• Craniofacial Surgery
• Infectious Disease Prevention

Background:

• Frontofacial surgery (FFS) involves creating a cranial-nasal cavity connection, posing a high risk for surgical-site infections (SSIs).
• A cluster of SSIs prompted an investigation, but no specific root cause was identified.
• Existing knowledge of SSI risk factors was leveraged to develop a targeted management protocol.

Purpose of the Study:

• To evaluate the effectiveness of a newly implemented perioperative management protocol in reducing SSIs after FFS.
• To analyze infection rates in FFS patients before and after protocol implementation.

Main Methods:

• A bespoke protocol comprising preoperative, intraoperative, and postoperative checklists was developed.
• Patient data from 1999-2019 were retrospectively analyzed, comparing infection rates pre- and post-protocol implementation (August 2013).
• Protocol compliance was assessed, and infection rates were statistically analyzed.

Main Results:

• A total of 133 FFS patients were included (103 pre-protocol, 30 post-protocol).
• Protocol compliance reached 95% post-implementation.
• A significant reduction in infection rates was observed, decreasing from 41.7% to 13.3% (P = 0.005).

Conclusions:

• The implementation of a structured, checklist-based perioperative protocol significantly decreased SSIs in FFS patients.
• This protocol, based on known infection prevention principles, effectively mitigated postoperative infection risks.
• The study demonstrates the value of standardized protocols in improving surgical safety for FFS.