Artikel
Surgical site infection after craniotomy – identifiying risk factors based on a matched pair analysis
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Veröffentlicht: | 8. Juni 2016 |
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Objective: Surgical site infections (SSIs) in neurosurgical patients after craniotomy result in additional morbidity. Our study is aimed at analysing risk factors for SSIs in order to identify patient groups at high risk for infectious complications.
Method: We performed a retrospective chart review of all patients undergoing craniotomy between January 2012 and March 2015 at the Klinik für Neurochirurgie, Universitätsklinikum Muenster. The complete medical records of each case were reviewed and all SSIs with the need of surgical intervention were recorded. A matched case-control study design was used, with 70 patients, who developed SSIs after craniotomy (cases) matched with 185 controls. Statistical analyses were performed using both univariate and multivariate models to identify risk factors associated with SSIs.
Results: A total of 70 cases of SSIs were identified among 2819 patients, who underwent craniotomy in our department and included in the study, with a resulting overall infection rate of 2,47%. The time of the onset of SSIs ranged from 8 to 854 days after surgery (median: 42 days). Cultures were obtained in 91.7 % of cases (n= 64) being positive for organisms in 72.9 % of cases (n= 51). The most frequent microorganisms found were staphylococcus aureus (n= 23. 32.9%) and staphylococcus epidermidis (n= 6, 8.6%). 58.6% (n=41) were deep incisional or organ space infections. ASA-Score (p= 0.003), surgical drain (p< 0.001), number of previous operations (p< 0.001) and implantation of foreign material (p< 0.001) were significant risk factors for SSIs in mulitvariate analysis. Previous chemotherapy, radiotherapy, smoking and diabetes mellitus were not significantly associated with SSIs. Deep incisional or organ space infections were significantly associated with the male gender and the presence of foreign material.
Conclusions: The present data indicate a low incidence of postoperative wound infection in our surgical spectrum using modern techniques and single shot antibiotic prophylaxis. However, wound infections remain an important problem in neurosurgery as they cause further complications, major costs and prolong hospital stay. Our study identified risk factors for SSIs, enabling a prospective assessment of a patient's risk of SSI based on pre- and postoperative risk factors. This knowledge could help modifying some processes of care with the aim to lower the incidence of SSIs and therefore improve patient outcome.