Abstract
Purpose
Postoperative surgical site infections (SSIs) constitute a significant source of morbidity for neurosurgical patients. Protocols that minimize postoperative wound infections are integral to improving outcomes and curtailing expenditures. The present study seeks to identify risk factors for infection and assess the efficacy of prophylactic betadine irrigation and vancomycin powder in addition to standard antibiotic irrigation.
Methods
We reviewed craniotomies performed by THS at Weill Cornell/New York Presbyterian Hospital to treat neuro-oncologic pathology. Patients were divided into three groups: group 1 — antibiotic irrigation, group 2 — antibiotic irrigation and betadine irrigation, group 3 — antibiotic irrigation, betadine irrigation, and vancomycin powder. SSI was confirmed with bacterial culture. Risk factor identification and assessment of treatment paradigms was performed using chi-square tests and univariate logistic regression.
Results
Among 1209 total patients, the 30- and 90-day SSI rates were 1.7% and 3.5%, respectively. Significant predictors of SSI included preoperative use of bevacizumab (OR 40.84; p < 0.0001), foreign body (OR 4.06; p < 0.0001), prior radiation (OR 2.20; p = 0.03), and prior operation/biopsy (OR 1.92; p = 0.04). Risk of infection was 2.1% in low-risk cases and 6.9% in high-risk cases. A significant, incremental decrement in SSIs was identified between the prophylaxis groups, although only among low-risk cases: group 1: 4.53%, group 2: 1.39%, group 3: 0.42% (p = 0.02). Neither vancomycin powder nor betadine significantly reduced the risk of SSI in patients with one or more risk factors.
Conclusion
Vancomycin powder with betadine irrigation decreased SSI rates following neuro-oncologic cranial procedures in patients at low risk of infection (i.e., no preoperative risk factors).
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References
Abdullah KG, Attiah MA, Olsen AS, Richardson A, Lucas TH (2015) Reducing surgical site infections following craniotomy: examination of the use of topical vancomycin. J Neurosurg 123(6):1600–1604. https://doi.org/10.3171/2014.12.JNS142092
Barker FG. Efficacy of prophylactic antibiotics for craniotomy: a meta-analysis. Neurosurgery. 1994;35(3):484-490; discussion 491-492. https://doi.org/10.1227/00006123-199409000-00017
Bokhari R, You E, Zeiler FA et al (2019) Effect of intrawound vancomycin on surgical site infections in nonspinal neurosurgical procedures: a systematic review and meta-analysis. World Neurosurg 123:409-417.e7. https://doi.org/10.1016/j.wneu.2018.10.168
Buchanan IA, Donoho DA, Patel A et al (2018) Predictors of surgical site infection after nonemergent craniotomy: a nationwide readmission database analysis. World neurosurgery 120:e440–e452. https://doi.org/10.1016/j.wneu.2018.08.102
Bullock R, van Dellen JR, Ketelbey W, Reinach SG (1988) A double-blind placebo-controlled trial of perioperative prophylactic antibiotics for elective neurosurgery. J Neurosurg 69(5):687–691. https://doi.org/10.3171/jns.1988.69.5.0687
Chundamala J, Wright JG (2007) The efficacy and risks of using povidone-iodine irrigation to prevent surgical site infection: an evidence-based review. Can J Surg 50(6):473–481
Clark AJ, Butowski NA, Chang SM et al (2011) Impact of bevacizumab chemotherapy on craniotomy wound healing: clinical article. J Neurosurg 114(6):1609–1616. https://doi.org/10.3171/2010.10.JNS101042
Emile SH, Elfallal AH, Abdel-Razik MA, El-Said M, Elshobaky A (2020) A randomized controlled trial on irrigation of open appendectomy wound with gentamicin- saline solution versus saline solution for prevention of surgical site infection. Int J Surg 81:140–146. https://doi.org/10.1016/j.ijsu.2020.07.057
Fang C, Zhu T, Zhang P, Xia L, Sun C (2017) Risk factors of neurosurgical site infection after craniotomy: a systematic review and meta-analysis. Am J Infect Control 45(11):e123–e134. https://doi.org/10.1016/j.ajic.2017.06.009
Ghobrial GM, Cadotte DW, Williams K, Fehlings MG, Harrop JS (2015) Complications from the use of intrawound vancomycin in lumbar spinal surgery: a systematic review. Neurosurg Focus 39(4):E11. https://doi.org/10.3171/2015.7.FOCUS15258
González P, Lobato RD, Boto GR, De la Lama A, Lagares A, Alén JF (2000) Profilaxis antibiótica en neurocirugía. Neurocirugia 11(3):196–202. https://doi.org/10.1016/S1130-1473(00)70960-2
Korinek A-M, Baugnon T, Golmard J-L, van Effenterre R, Coriat P, Puybasset L (2008) Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery 62(Suppl 2):532–539. https://doi.org/10.1227/01.neu.0000316256.44349.b1
Korinek A-M, Golmard J-L, Elcheick A et al (2005) Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4,578 patients. Br J Neurosurg 19(2):155–162. https://doi.org/10.1080/02688690500145639
Mallela AN, Abdullah KG, Brandon C, Richardson AG, Lucas TH (2018) Topical vancomycin reduces surgical-site infections after craniotomy: a prospective, controlled study. Neurosurgery 83(4):761–767. https://doi.org/10.1093/neuros/nyx559
McClelland S, Hall WA (2007) Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis 45(1):55–59. https://doi.org/10.1086/518580
Mueller TC, Loos M, Haller B et al (2015) Intra-operative wound irrigation to reduce surgical site infections after abdominal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 400(2):167–181. https://doi.org/10.1007/s00423-015-1279-x
Patel KS, Goldenberg B, Schwartz TH (2014) Betadine irrigation and post-craniotomy wound infection. Clin Neurol Neurosurg 118:49–52. https://doi.org/10.1016/j.clineuro.2013.12.015
Ravikumar V, Ho AL, Pendhakar AV, Sussman ES, Kwong-Hon Chow K, Li G (2017) The use of vancomycin powder for surgical prophylaxis following craniotomy. Neurosurgery 80(5):754–758. https://doi.org/10.1093/neuros/nyw127
Sneh-Arbib O, Shiferstein A, Dagan N et al (2013) Surgical site infections following craniotomy focusing on possible post-operative acquisition of infection: prospective cohort study. Eur J Clin Microbiol Infect Dis 32(12):1511–1516. https://doi.org/10.1007/s10096-013-1904-y
Strobel RM, Leonhardt M, Krochmann A et al (2020) Reduction of postoperative wound infections by antiseptica (RECIPE)?: a randomized controlled trial. Ann Surg 272(1):55–64. https://doi.org/10.1097/SLA.0000000000003645
Strohecker J, Piotrowski WP, Lametschwandtner A. The intra-operative application of povidone-iodine in neurosurgery. J Hosp Infect. 1985;6 Suppl A:123-125. https://doi.org/10.1016/s0195-6701(85)80057-8
Tomov M, Mitsunaga L, Durbin-Johnson B, Nallur D, Roberto R (2015) Reducing surgical site infection in spinal surgery with Betadine irrigation and intra-wound vancomycin powder. Spine (Phila Pa 1976) 40(7):491–499. https://doi.org/10.1097/BRS.0000000000000789
Weiser T, Donaldson L, Gawande A (2009) WHO guidelines for safe surgery 2009: safe surgery saves lives. 2009;(WHO/IER/PSP/2008.08-1E):124
Willy C, Scheuermann-Poley C, Stichling M, von Stein T, Kramer A (2017) Importance of wound irrigation solutions and fluids with antiseptic effects in therapy and prophylaxis: update 2017. Unfallchirurg 120(7):549–560. https://doi.org/10.1007/s00113-017-0375-5
Funding
Jason Chua, MPH, and Paul Christos, DrPH, were partially supported by the following grant: Clinical and Translational Science Center at Weill Cornell Medical College (1-UL1-TR002384-01).
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Maayan, O., Babu, C., Tusa Lavieri, M.E. et al. Combined use of vancomycin powder and betadine irrigation lowers the incidence of postcraniotomy wound infection in low-risk cases: a single-center risk-stratified cohort analysis. Acta Neurochir 164, 867–874 (2022). https://doi.org/10.1007/s00701-021-05075-9
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DOI: https://doi.org/10.1007/s00701-021-05075-9