Incidence, depth, and severity of surgical site infections after neurosurgical interventions
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.
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).
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.
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.
KeywordsIncidence Complication Morbidity Neurosurgery Surgical site infection Treatment
Active surveillance culture
Active surveillance testing
Centers for Disease Control and Prevention
External ventricular drainage
Karnofsky Performance Status
Length of surgery
Magnetic resonance imaging
National Healthcare Safety Network
Surgical site infection
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.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
Scientific workup of the registry data was approved by the institutional review board and patient consent was waived.
- 2.ANQ (2013) Zusammenfassender Bericht 2010-2011 - Erfassung postoperativer Wundinfektionen -. http://www.anq.ch/fileadmin/redaktion/deutsch/20130619_Swissnoso_Surveillance_Juni_2010_September_2011_final_de.pdf. Last accessed 29 Aug 2018
- 5.CDC (2017) National Healthcare Safety Network (NHSN) Patient Safety Component Manual. http://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf. Last accessed 29 Aug 2018
- 7.Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRefGoogle Scholar
- 15.Koek MB, Wille JC, Isken MR, Voss A, van Benthem BH (2015) Post-discharge surveillance (PDS) for surgical site infections: a good method is more important than a long duration. Euro Surveill 20Google Scholar
- 26.Schenker P, Stieglitz L, Sick B, Stienen MN, Regli L, Sarnthein J (2018) Normal pressure hydrocephalus shunt patients have fewer complications than other shunt patients. World Neurosurg 110:e249–e257. https://doi.org/10.1016/j.wneu.2017.10.151
- 30.Stienen MN, Zhang DY, Broggi M, Seggewiss D, Villa S, Schiavolin S, Bozinov O, Krayenbuhl N, Sarnthein J, Ferroli P, Regli L (2018) The influence of preoperative dependency on mortality, functional recovery and complications after microsurgical resection of intracranial tumors. J Neuro-Oncol 139:441–448CrossRefGoogle Scholar
- 31.WHO (2016) Global guidelines for the prevention of surgical site infection. WHO Document Production Services Geneva, GenevaGoogle Scholar
- 32.Zarb P, Coignard B, Griskeviciene J, Muller A, Vankerckhoven V, Weist K, Goossens M, Vaerenberg S, Hopkins S, Catry B, Monnet D, Goossens H, Suetens C (2012) The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use. Euro Surveill 17. https://doi.org/10.2807/ese.17.46.20316-en