Medical Student University of Illinois College of Medicine at Chicago Chicago, Illinois, United States
Introduction: Surgical site infection (SSI) is a feared complication in neurological surgery causing significant burden to both patients and the healthcare system. Though many risk factors have been previously identified, SSI prevention continues to be a challenge. The purpose of this study is to identify novel perioperative procedural and equipment-related risk factors for SSI in cranial and neurosurgical spine procedures to help guide SSI prevention.
Methods: Perioperative factors for patients who underwent cranial or spine surgery at a single surgical center between 2005 and 2020 were collected through retrospective chart reviews. Patients were categorized as either SSI or non-SSI. Multivariate logistic regression was used to assess the impact of perioperative procedural factors on SSI (ɑ=0.05).
Results: 86 patients who underwent cranial procedures excluding shunts (35 SSI vs. 51 non-SSI) and 81 patients who underwent spine procedures (51 SSI vs. 30 non-SSI) were identified. In cranial patients, longer operative time (OR=1.001, p=0.006), use of an intracranial pressure monitor or cerebrospinal fluid drain (OR=22.86, p=0.004), and use of a surgical microscope (OR=13.28, p=0.01) were associated with SSI. In spine patients, fewer neurosurgeons and trainees present at the surgical field (OR=0.036, p=0.001) and use of C-arm fluoroscopy (OR=42.14, p< 0.001) were associated with SSI. Notably, factors such as use of stereotactic navigation, implantation of surgical devices, and intraoperative blood loss were not associated with SSI in either cohort.
Conclusion : Novel perioperative factors associated with SSI in cranial and neurosurgical spine patients were identified at a single surgical center. Further observational investigation is warranted to evaluate causal procedural factors for each vector of infection. Doing so may help improve neurosurgical processes at this and other similar surgical centers, thus reducing overall rates of postoperative SSI.
