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Incidence and Risk Factors of Postoperative Meningitis Following Endoscopic Endonasal Transsphenoidal Surgery: A
Panu Boontoterm1, Siraruj Sakoolnamarka2, Karanarak Urasyanandana1
1Neurological Surgery Unit, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand.
Objectives:
Postoperative meningitis following endoscopic endonasal transsphenoidal surgery (TSS) is a critical outcome metric. Meningitis is one of the most severe complications in neurosurgery, particularly with transsphenoidal procedures, due to the potential for bacterial contamination from the nasal or sinus cavities. Identifying the risk factors associated with postoperative meningitis is crucial for preventing and minimizing this risk in future surgeries.
Materials And Methods:
The study reviewed admission forms, operative notes, and the occurrence of various complications in patients who underwent the TSS approach between 2010 and 2024, focusing on variations in health care access and surgical practices.
Statistical Analysis:
Descriptive statistics will summarize demographic, surgical, and clinical characteristics. Univariate analysis: risk factors for meningitis could be evaluated through chi-square tests for categorical variables (e.g., presence of a cerebrospinal fluid [CSF] leak) and t -tests or analysis of variance for continuous variables (e.g., age, surgery duration). Multivariate logistic regression: to identify independent predictors of meningitis, logistic regression could be used.
Results:
A total of 237 patients who underwent TSS between 2010 and 2024 were included in the final analysis. The overall incidence of postoperative meningitis was 23%. Intra- and postoperative CSF leakage, diabetes mellitus, obesity, and previous sinus or nasal infection were found to be a significant factor associated with postoperative meningitis.
Conclusion:
Understanding the risk factors for meningitis following TSS is crucial for improving patient outcomes. While preoperative nares cleaning with normal saline may reduce nasal congestion, our findings indicate that it does not significantly affect the rate of postoperative meningitis compared with Hibitane-only cleaning.
Insights
Postoperative meningitis after transsphenoidal surgery (TSS) affects 23% of patients. Key risk factors include cerebrospinal fluid leaks, diabetes, obesity, and prior sinus infections, informing preventative strategies.
Area of Science:
- Neurosurgery
- Infectious Disease Epidemiology
Background:
- Postoperative meningitis is a severe complication of transsphenoidal surgery (TSS).
- Identifying risk factors for meningitis post-TSS is crucial for patient safety and improved surgical outcomes.
- Bacterial contamination from nasal/sinus cavities poses a significant risk.
Purpose of the Study:
- To identify and analyze risk factors associated with postoperative meningitis following endoscopic endonasal transsphenoidal surgery (TSS).
- To evaluate the incidence of meningitis in patients undergoing TSS.
- To inform preventative measures and optimize surgical protocols.
Main Methods:
- Retrospective review of 237 patients undergoing TSS between 2010 and 2024.
- Analysis of admission forms, operative notes, and complication occurrences.
- Statistical analysis including univariate and multivariate logistic regression to identify predictors of meningitis.
Main Results:
- The overall incidence of postoperative meningitis was 23%.
- Significant risk factors identified include intraoperative and postoperative cerebrospinal fluid (CSF) leakage, diabetes mellitus, obesity, and history of sinus or nasal infection.
- Preoperative nasal cleaning with normal saline did not significantly impact meningitis rates compared to Hibitane-only cleaning.
Conclusions:
- Cerebrospinal fluid leakage, diabetes, obesity, and prior infections are significant risk factors for meningitis after TSS.
- Understanding these risk factors is vital for enhancing patient outcomes and reducing complication rates.
- Current preoperative nasal cleaning protocols may not effectively reduce meningitis incidence.
