Risk Factors of Post-Craniotomy Surgical Site Infection: A Retrospective Study

Background: Although surgical site infection following craniotomy (SSI-CRAN) is uncommon, it is a significant complication of surgical procedures. In addition, it imposes a considerable disease burden on patients and healthcare systems regarding morbidity, mortality, and economic costs. Despite that, the risk factors for its development are unknown. Therefore, identifying the risk factors for SSI-CRAN enables the determination and implementation of preventative measures to lower the infection rate. Methods: This retrospective cohort research was conducted on patients who underwent craniotomy operation for any indication from January 01, 2011 to December 31, 2020 in the neuroscience center at King Fahad Medical City (Riyadh, Saudi Arabia) to determine risk factors for SSIs. Many patient-related and procedure-related factors were tested as possible risk factors for craniotomy SSI. Results: This 9-year retrospective study found an overall SSI-CRAN rate of 3.02%. Gram-negative bacteria were the predominant causative pathogen (75.35%). Cerebrospinal fluid leak (odds ratio [OR]: 18, 95% confidence interval [CI]: 9.50-34.0), seizure (OR: 30.50, 95% CI: 16.3-57.2), history of hypertension (OR: 14.9, 95% CI: 8.2-27.1), bronchial asthma (OR: 3.80, 95% CI: 1.5-9.5), and history of epilepsy (OR: 7.20, 95% CI: 3.0-17.40) were associated with an increased risk of post-operative SSIs in the multivariable regression analysis model. No significant associations with gender, age, American Society of Anesthesiologists class, body mass index, use of pre- or post-operative antibiotic agents, duration of surgical procedure, number of operations, length of stay, or risk index have been found. Conclusion: The risk parameters and causal agents for SSI-CRAN found in this study should be considered when developing preventative strategies to reduce this devastating complication's incidence. Identifying risk factors for SSI should aid in improving patient treatment and declining mortality, morbidity, and the economic burden associated with healthcare costs. Post-operative surveillance is also critical for identifying reliable risk parameters for SSI.