Surgical site infection risk factors [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== Surgical site infection risk factors ======

{{ ::surgical_site_infection.png?200|}}

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1rYqyBTl7b-1Gg1O4RrUF77gHJ6nk9IKA9xAbd15nPIbw40AnT/?limit=15&utm_campaign=pubmed-2&fc=20230115163111}}
----

----

Emergency, clean-contaminated [[wound]] or dirty surgery, operative time >4 hours, reoperation, and implanted materials are independent predictive factors for postoperative infections after craniotomy
((Korinek AM. Risk factors for neurosurgical site infections after craniotomy: a prospective multicenter study of 2944 patients. The French Study Group of Neurosurgical Infections, the SEHP, and the C-CLIN Paris-Nord. Service Epidémiologie Hygiène et Prévention. Neurosurgery. 1997 Nov;41(5):1073-9; discussion 1079-81. doi: 10.1097/00006123-199711000-00010. PMID: 9361061.)).

Having other medical problems or diseases

Being an elderly adult

Being overweight

Smoking

Having cancer

Having a weak immune system

Having diabetes

Having emergency surgery

Having abdominal surgery



----


Of 16,513 patients in a study, 1.20% required at least one further operation to treat a [[surgical site infection]] (SSI). Wound [[leak]] (odds ratio [OR]: 27.41), [[dexamethasone]] use (OR: 3.55), [[instrumentation]] (OR: 2.74) and [[operative time]] >180 minutes (OR: 1.85) were statistically significant risk factors for [[reoperation]]
((Patel S, Thompson D, Innocent S, Narbad V, Selway R, Barkas K. Risk factors
for surgical site infections in neurosurgery. Ann R Coll Surg Engl. 2019
Mar;101(3):220-225. doi: 10.1308/rcsann.2019.0001. Epub 2019 Jan 30. PubMed PMID:
30698457; PubMed Central PMCID: PMC6400918.
)).
----


It is still discussed if the dual use increases the [[risk]] of [[surgical site infection]]s (SSI).Increase of [[extent of tumor resection]] using [[intraoperative magnetic resonance imaging]] (iMRI) is evident. SSI rate is within the normal range of [[neurosurgical procedure]]s. A dual-use iMRI suite is a safe concept
((Wach J, Goetz C, Shareghi K, Scholz T, Heßelmann V, Mager AK, Gottschalk J,
Vatter H, Kremer P. Dual-Use Intraoperative MRI in Glioblastoma Surgery: Results 
of Resection, Histopathologic Assessment, and Surgical Site Infections. J Neurol 
Surg A Cent Eur Neurosurg. 2019 Jul 4. doi: 10.1055/s-0039-1692975. [Epub ahead
of print] PubMed PMID: 31272122.
)).

----
Despite the general consensus on the use of single-dose antimicrobial prophylaxis (AMP) in instrumented spine surgery, evidence supporting this approach is not robust.
Analysis of individual categories of data suggests that 72 h prophylaxis was the most important factor for minimizing the risk of wound infection in a study group
((Maciejczak A, Wolan-Nieroda A, Wałaszek M, Kołpa M, Wolak Z. Antibiotic
prophylaxis in spine surgery: a comparison of single-dose and 72-hour protocols. 
J Hosp Infect. 2019 Apr 30. pii: S0195-6701(19)30186-0. doi:
10.1016/j.jhin.2019.04.017. [Epub ahead of print] PubMed PMID: 31051190.)).
----
Cassir et al. identified the following independent risk factors for SSI postcranial surgery: intensive care unit (ICU) length of stay ≥7 days (odds ratio [OR] = 6.1; 95% [[confidence interval]] [CI], 1.7-21.7), duration of drainage ≥3 days (OR = 3.3; 95% CI, 1.1-11), and Cerebrospinal fluid fistula (OR = 5.6; 95% CI, 1.1-30). 

For SSIs postspinal surgery, they identified the following: ICU length of stay ≥7 days (OR = 7.2; 95% CI, 1.6-32.1), [[coinfection]] (OR = 9.9; 95% CI, 2.2-43.4), and duration of drainage ≥3 days (OR = 5.7; 95% CI, 1.5-22)
((Cassir N, De La Rosa S, Melot A, Touta A, Troude L, Loundou A, Richet H, Roche
PH. Risk factors for surgical site infections after neurosurgery: A focus on the 
postoperative period. Am J Infect Control. 2015 Aug 20. pii:
S0196-6553(15)00756-7. doi: 10.1016/j.ajic.2015.07.005. [Epub ahead of print]
PubMed PMID: 26300100.
)).

===== Subcutaneous fat thickness =====

[[Nuchal thickness]] and [[subcutaneous]] fat thickness are associated with [[SSI]], in patients undergoing [[posterior cervical spine surgery]]. The risk of [[infection]] increases with very thin and very thick nuchal measurements
((Porche K, Lockney DT, Gooldy T, Kubilis P, Murad G. [[Nuchal thickness]] and increased risk of [[surgical site infection]] in posterior cervical operations. Clin Neurol Neurosurg. 2021 Apr 25;205:106653. doi: 10.1016/j.clineuro.2021.106653. Epub ahead of print. PMID: 33984797.)).
----
Local subcutaneous fat thickness is a better indicator for predicting incision infection compared with BMI. In diabetic patients undergoing lumbar surgery, actively controlling blood glucose fluctuations, restoring normal diet early after surgery, and optimizing surgical procedures to reduce trauma and operative time can effectively reduce the risk of infection after posterior lumbar surgery
((Peng W, Liang Y, Lu T, Li M, Li DS, Du KH, Wu JH. Multivariate analysis of
incision infection after posterior lumbar surgery in diabetic patients: A
single-center retrospective analysis. Medicine (Baltimore). 2019
Jun;98(23):e15935. doi: 10.1097/MD.0000000000015935. PubMed PMID: 31169714.
)).
----


Many patients carry a label of penicillin allergy, either because they have experienced an allergic reaction to penicillin in the past or because they were mistakenly labeled as allergic due to other symptoms. This can result in the use of alternative, less effective antibiotics for surgical prophylaxis or treatment of infections, which can increase the risk of adverse outcomes such as [[surgical site infection]]s.
===== References =====