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Incidence, depth, and severity of surgical site infections after neurosurgical interventions

  • Original Article - Infection
  • Published:
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Abstract

Background

Today, there are only few reports on the incidence of surgical site infections (SSIs) in neurosurgery. The objective of this work was to determine the rate of SSI at a tertiary neurosurgical department for benchmarking purpose.

Methods

Data of consecutive patients undergoing neurosurgical treatment between January 2013 and December 2016 were prospectively entered into a registry. SSIs were diagnosed according to the 2017 Centers for Disease Control and Prevention criteria, with severity graded according to the Clavien-Dindo grade (CDG). We analyzed type and length of surgery (LOS), time to SSI, responsible microorganisms, and its association with the functional status (Karnofsky Performance Status = KPS).

Results

Of n = 5463 procedures, a SSI occurred in n = 106 (1.94%). The highest rates of SSI occurred after vascular (3.4%) and cerebrospinal fluid (CSF) diversion procedures (3%), as well as after procedures performed to treat a previous complication (2.9%). There was no difference in LOS across procedures with and without SSI. The median time between the index procedure and SSI was 15.5 days. SSIs were most frequently diagnosed after hospital discharge (55%). The most common microorganisms were coagulase-negative staphylococci, Staphylococcus aureus, and Escherichia coli. In 62.3% of cases, SSI required invasive treatment (surgical revision). Patients with SSI in the in- and out-patient setting (SSI occurring after hospital discharge) presented both with a median KPS of 80.

Conclusions

The current report provides an overview on SSI in a contemporary, unselected, large series of patients undergoing modern neurosurgical care for benchmarking purposes. The overall rate of SSI was about 2%, but subpopulations with higher risks were identified where additional measures could be taken to prevent SSI and monitor patients at risk more closely for SSI.

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Abbreviations

ASC:

Active surveillance culture

AST:

Active surveillance testing

CDC:

Centers for Disease Control and Prevention

CDG:

Clavien-Dindo grade

CI:

Confidence interval

CoNS:

Coagulase-negative staphylococci

CSF:

Cerebrospinal fluid

EVD:

External ventricular drainage

HIA:

Healthcare-associated infection

IQR:

Interquartile range

KPS:

Karnofsky Performance Status

LOS:

Length of surgery

MRI:

Magnetic resonance imaging

NHSN:

National Healthcare Safety Network

OR:

Odds ratio

sp.:

Species

SSI:

Surgical site infection

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Acknowledgements

The authors thank all resident and faculty neurosurgeons who entered and validated the patient data in the institutional patient registry that were basis of this research.

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Author notes

  1. Martin N. Stienen and Nathalie Moser contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland

    Martin N. Stienen, Nathalie Moser, Philipp Krauss, Luca Regli & Johannes Sarnthein

Authors
  1. Martin N. Stienen
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  2. Nathalie Moser
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  3. Philipp Krauss
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  4. Luca Regli
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  5. Johannes Sarnthein
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Corresponding author

Correspondence to Martin N. Stienen.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

Scientific workup of the registry data was approved by the institutional review board and patient consent was waived.

Additional information

This article is part of the Topical Collection on Infection

Electronic supplementary material

Supplementary Table 1

Centers for Disease Control and Prevention (CDC) Surgical Site Infection (SSI) criteria - incisional SSI (superficial and deep). [5] ASC = Active Surveillance Culture; AST = Active Surveillance Testing; NHSN = National Healthcare Safety Network. (DOCX 91 kb)

Supplementary Table 2

Centers for Disease Control and Prevention (CDC) Surgical Site Infection (SSI) criteria – organ/space SSI. [5] ASC = Active Surveillance Culture; AST = Active Surveillance Testing. (DOCX 68 kb)

Supplementary Table 3

Specific sites of an organ/space surgical site infection (SSI). [5] (DOCX 37 kb)

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Stienen, M.N., Moser, N., Krauss, P. et al. Incidence, depth, and severity of surgical site infections after neurosurgical interventions. Acta Neurochir 161, 17–24 (2019). https://doi.org/10.1007/s00701-018-3745-z

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  • DOI: https://doi.org/10.1007/s00701-018-3745-z

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