Surgical site infection risk factors

Surgical site infection risk factors

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 1).


It is still discussed if the dual use increases the risk of surgical site infections (SSI).Increase of extent of tumor resection using intraoperative magnetic resonance imaging (iMRI) is evident. SSI rate is within the normal range of neurosurgical procedures. A dual-use iMRI suite is a safe concept 2).


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 3).


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 leakage (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) 4).

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 5).


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 6).


1)

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.
2)

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.
3)

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.
4)

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.
5)

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.
6)

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.

3D NEUROANATOMY – Intrinsic brain anatomy and surgical approaches

THURSDAY 5th MODULE

1: Surface Surgical Anatomy. – Phylogenetic evolution of the human brain. – The cerebral lobes. – Craniometric points of the skull. – Brain surface functional understanding through intraoperative mapping.

MODULE 2: The Cerebral Substance (I). – The white matter of the human brain. – Lateral dorsal & ventral tracts. – How I do it: awake surgery. – Technical adjuncts for glioma surgery. – How I do it: endoscopic assisted glioma surgery.

SURGICAL STATION 1: Hands-On. – Intrinsic brain tumor resection on a 3D printed model.

SURGICAL STATION 2: Break-out Session. – The case for discussion: INSULAR GLIOMA.

SURGICAL STATION 3: Quiz Session. – Sulco-gyral organization and cortical 3D understanding based on real cases.

Ischemic Stroke Management Medical Interventional and Surgical Management

Ischemic Stroke Management Medical Interventional and Surgical Management

by Alejandro Spiotta (Author), Roberto Crosa Erroyzarena (Author)

List Price: $129.99

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A complete guide to improving stroke treatment and patient outcomes from international experts!

Of the more than 795,000 estimated strokes that occur annually in the U.S., 87% are ischemic due to blockages, while the remaining 13% are hemorrhagic associated with spontaneous bleeding in the brain. Ischemic Stroke Management: Medical, Interventional and Surgical Management by esteemed neurosurgeons Alejandro Spiotta, Roberto Crosa, and an impressive group of international contributors details evidence-based medical, interventional, and neurosurgical treatment of ischemic stroke.

Twelve chapters cover complete management of ischemic stroke, from symptom manifestation to interventions in the ER, OR, and NICU. The first chapters cover stroke epidemiology, intravenous thrombolysis in stroke, and the crucial role stroke centers play in ensuring timely treatment of this devastating disease. Subsequent chapters discuss diagnostic imaging techniques in acute ischemic stroke, neurosurgical interventions for hemorrhagic and ischemic stroke, and neuroanesthesia considerations.

Key Features

With contributions from South America to Europe, North America to Asia, authors share diverse experiences treating stroke patients, delivering a unique international perspective

Endovascular neurosurgery ischemic stroke approaches and discussion of scientific evidence

Mechanical thrombectomy utilizing Catch, Trevo, and Solitaire stent retrievers and the evolution of direct clot aspiration approaches

Special topics include neurocritical care of acute ischemic stroke, pediatric stroke, and emerging state-of-the-art techniques

Truly global viewpoints encompassed in this unique book make it a must-read for trainee and veteran neurosurgeons and interventional neuroradiologists across the world. This resource is also an essential bookshelf addition for medical centers worldwide that treat stroke patients.

This book includes complimentary access to a digital copy on https://medone.thieme.com.

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