• World Neurosurg · Dec 2018

    Excessive Hemostasis on the Scalp Increases Superficial Surgical Site Infection Rate in Cranioplasty.

    • Wen-Jian Zheng, Liang-Ming Li, Zi-Hui Hu, Wei Liao, Qi-Chang Lin, Yong-Hua Zhu, and Shao-Hua Lin.
    • Department of Neurosurgery, Zhongshan City People's Hospital, Zhongshan, China. Electronic address: 297229614@qq.com.
    • World Neurosurg. 2018 Dec 1; 120: e811-e817.

    BackgroundCranioplasty is a routine procedure, but it carries a significantly higher complication rate over standard clean cranial surgery. Surgical site infection is the most common but severe complication. Risk factors for surgical site infection are still debated.MethodsA retrospective survey of 155 patients (≥16 years old) who exclusively underwent customized titanium cranioplasty from April 2014 to January 2017 was performed. Preoperative clinical parameters, surgeon's hemostasis technique, temporalis dissection, operative time, intraoperative blood loss, postoperative catheter duration and drainage, postoperative hemorrhage and extradural fluid collection (EDFC), and prophylactic antibiotics were recorded and compared between patients with superficial surgical site infection (sSSI) and patients with non-sSSI.ResultsOverall sSSI rate was 10.3%. Binary logistic analysis showed excessive hemostasis on scalp (odds ratio = 10.302, P = 0.000), presence of postoperative EDFC (odds ratio = 12.740, P = 0.003), and postoperative drainage >277 mL (odds ratio = 10.302, P = 0.000) were independent risk factors for sSSI. Patients who received excessive hemostasis had a longer operative time (P = 0.000). A flaccid cranial defect was a protective factor for postoperative EDFC (odds ratio = 0.130, P = 0.044), whereas presence of ventriculoperitoneal shunt could induce EDFC formation (odds ratio = 9.598, P = 0.020). Postoperative subgaleal drainage was correlated to the size of cranial defect (standardized β = 0.347, P = 0.000). Timing of cranioplasty and use of prophylactic antibiotics were not related to sSSI.ConclusionsSurgeons should lower the hemostasis standard for cranioplasty, as this would promote wound healing and reduce operative time, which subsequently decreases SSI rate.Copyright © 2018 Elsevier Inc. All rights reserved.

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