Catherine Le1, Kern H Guppy2, Yekaterina V Axelrod2, Mark W Hawk2, James Silverthorn2, Maria C Inacio3, Paul T Akins4. 1. University of California Los Angeles, Neurocritical Care Department, Los Angeles, USA. 2. Kaiser Sacramento Neurosurgery Department, 2025 Morse Avenue, Sacramento, 95825, USA. 3. Kaiser Surgical Implant Registry, 8954 Rio San Diego Drive, Suite 406, San Diego, 92108, USA. 4. Kaiser Sacramento Neurosurgery Department, 2025 Morse Avenue, Sacramento, 95825, USA. Electronic address: paul.t.akins@kp.org.
Abstract
BACKGROUND: The overall benefits of craniectomy must include procedural risks from cranioplasty. Cranioplasty carries a high risk of surgical site infections (SSI) particularly with antibiotic resistant bacteria. The goal of this study was to measure the effect of a cranioplasty bundle on peri-operative complications. METHODS: The authors queried a prospective, inpatient neurosurgery database at Kaiser Sacramento Medical Center for craniectomy and cranioplasty over a 7 year period. 57 patients who underwent cranioplasties were identified. A retrospective chart review was completed for complications, including surgical complications such as SSI, wound dehiscence, and re-do cranioplasty. We measured cranioplasty complication rates before and after implementation of a peri-operative bundle, which consisted of peri-operative vancomycin (4 doses), a barrier dressing through post-operative day (POD) 3, and de-colonization of the surgical incision using topical chlorhexidine from POD 4 to 7. RESULTS: The rate of MRSA colonization in cranioplasty patients is three times higher than the average seen on ICU admission screening (19% vs. 6%). The cranioplasty surgical complication rate was 22.8% and SSI rate was 10.5%. The concurrent SSI rate for craniectomy was 1.9%. Organisms isolated were methicillin-resistant Staphylococcus aureus (4), methicillin-sensitive S. aureus (1), Propionibacterium acnes (1), and Escherichia coli (1). Factors associated with SSI were peri-operative vancomycin (68.6% vs. 16.7%, p=0.0217). Complication rates without (n=21) and with (n=36) the bundle were: SSI (23.8% vs. 2.8%, p=0.0217) and redo cranioplasty (19% vs. 0%, p=0.0152). Bundle use did not affect rates for superficial wound dehiscence, seizures, or hydrocephalus. CONCLUSIONS: The cranioplasty bundle was associated with reduced SSI rates and the need for re-do cranioplasties.
BACKGROUND: The overall benefits of craniectomy must include procedural risks from cranioplasty. Cranioplasty carries a high risk of surgical site infections (SSI) particularly with antibiotic resistant bacteria. The goal of this study was to measure the effect of a cranioplasty bundle on peri-operative complications. METHODS: The authors queried a prospective, inpatient neurosurgery database at Kaiser Sacramento Medical Center for craniectomy and cranioplasty over a 7 year period. 57 patients who underwent cranioplasties were identified. A retrospective chart review was completed for complications, including surgical complications such as SSI, wound dehiscence, and re-do cranioplasty. We measured cranioplasty complication rates before and after implementation of a peri-operative bundle, which consisted of peri-operative vancomycin (4 doses), a barrier dressing through post-operative day (POD) 3, and de-colonization of the surgical incision using topical chlorhexidine from POD 4 to 7. RESULTS: The rate of MRSA colonization in cranioplasty patients is three times higher than the average seen on ICU admission screening (19% vs. 6%). The cranioplasty surgical complication rate was 22.8% and SSI rate was 10.5%. The concurrent SSI rate for craniectomy was 1.9%. Organisms isolated were methicillin-resistant Staphylococcus aureus (4), methicillin-sensitive S. aureus (1), Propionibacterium acnes (1), and Escherichia coli (1). Factors associated with SSI were peri-operative vancomycin (68.6% vs. 16.7%, p=0.0217). Complication rates without (n=21) and with (n=36) the bundle were: SSI (23.8% vs. 2.8%, p=0.0217) and redo cranioplasty (19% vs. 0%, p=0.0152). Bundle use did not affect rates for superficial wound dehiscence, seizures, or hydrocephalus. CONCLUSIONS: The cranioplasty bundle was associated with reduced SSI rates and the need for re-do cranioplasties.
Authors: Paul T Akins; Amit Banerjee; Kern Guppy; James Silverthorn; John Fitzgibbon; Yogesh Nandan; Elaine O Yu; Luis Pacheco; Jack Rozance; Rob Azevedo; James Chang; Mark W Hawk Journal: Perm J Date: 2019-10-18
Authors: Kingsley O Abode-Iyamah; Hsiu-Yin Chiang; Nolan Winslow; Brian Park; Mario Zanaty; Brian J Dlouhy; Oliver E Flouty; Zachary D Rasmussen; Loreen A Herwaldt; Jeremy D Greenlee Journal: J Neurosurg Date: 2017-05-12 Impact factor: 5.115