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What factors are associated with surgical site infections after intracranial neurosurgical procedures? An exploratory
I-L Böregård1, L Arvidsson2, S Bringman3
1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Anaesthesia, Södertälje Hospital, Södertälje, Sweden.
Background:
Surgical site infections (SSIs) after intracranial neurosurgical procedures derive from both endogenous and exogenous factors, and are associated with increased morbidity, mortality and additional socio-economic costs. The addition of mobile laminar airflow (MLAF) units to the operating room ventilation decreases bacteria-carrying particles, but their influence on the incidence of SSIs, and concurrence with other factors, is unclear. This is a continuation study of a previous study using MLAF units.
Aim:
To explore factors associated with SSIs after intracranial procedures during a period when MLAF units were used.
Methods:
This retrospective register study had an explorative design. The electronic medical records of patients undergoing intracranial neurosurgical procedures were reviewed retrospectively for signs or symptoms of SSIs using a 45-item protocol. Demographic, patient-specific and procedure-specific variables were collected, as well as exogenous factors and SSI variables regarding depth of SSI, type of bacteria, time to infection, and treatment. Data were analysed using univariate and multi-variate logistic regression.
Findings:
An SSI occurred in 55 of 800 included patients (6.9%). On univariate and multi-variate analysis, only remote infections during the hospital stay were associated with risk of SSI (odds ratio 2.02, 95% confidence interval 1.07-3.82; P=0.031). Superficial SSIs were most common, the median time to infection was 18 days, and the most common causative micro-organism was Staphylococcus aureus.
Conclusions:
In the clinical context, considerations are recommended for neurosurgical patients with ongoing remote infections during their hospital stay. Further peri-operative studies are needed in the field of surgical infection prevention.
Insights
Patients with remote infections during hospital stays face a higher risk of surgical site infections (SSIs) after neurosurgery. This study explored factors associated with SSIs in patients undergoing intracranial procedures.
Area of Science:
- Neurosurgery
- Infectious Disease Epidemiology
- Healthcare-Associated Infections
Background:
- Surgical site infections (SSIs) increase morbidity, mortality, and costs following intracranial neurosurgery.
- Mobile laminar airflow (MLAF) units may reduce airborne bacteria, but their impact on SSIs and co-existing factors remains unclear.
- This study continues previous research on MLAF units in neurosurgical operating rooms.
Purpose of the Study:
- To identify factors associated with SSIs in patients undergoing intracranial procedures.
- To evaluate the clinical context during the use of MLAF units.
- To inform strategies for surgical infection prevention in neurosurgery.
Main Methods:
- Retrospective explorative register study design.
- Review of electronic medical records for 800 patients undergoing intracranial neurosurgery.
- Data collection included patient demographics, procedure details, exogenous factors, and SSI characteristics; analyzed using logistic regression.
Main Results:
- An SSI incidence of 6.9% (55/800 patients) was observed.
- Remote infections during hospital stay significantly increased SSI risk (OR 2.02, P=0.031).
- Superficial SSIs were most frequent, Staphylococcus aureus was the commonest pathogen, and median infection time was 18 days.
Conclusions:
- Neurosurgical patients with concurrent remote infections require careful consideration to mitigate SSI risk.
- Further peri-operative research is essential for advancing surgical infection prevention strategies.
- The findings highlight the importance of managing hospital-acquired infections in neurosurgical patients.
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