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Acta Neurochirurgica

, Volume 161, Issue 1, pp 17–24 | Cite as

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

  • Martin N. Stienen
  • Nathalie Moser
  • Philipp Krauss
  • Luca Regli
  • Johannes Sarnthein
Original Article - Infection
  • 51 Downloads
Part of the following topical collections:
  1. Infection

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.

Keywords

Incidence Complication Morbidity Neurosurgery Surgical site infection Treatment 

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

Notes

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.

Compliance with ethical standards

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.

Supplementary material

701_2018_3745_MOESM1_ESM.docx (91 kb)
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)
701_2018_3745_MOESM2_ESM.docx (68 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)
701_2018_3745_MOESM3_ESM.docx (38 kb)
Supplementary Table 3 Specific sites of an organ/space surgical site infection (SSI). [5] (DOCX 37 kb)

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Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience CenterUniversity of ZurichZurichSwitzerland

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