When the Infection Hits the Wound: Matched Case-Control Study in a Neurosurgical Patient Collective Including Systematic Literature Review and Risk Factors Analysis

BACKGROUND: To avoid surgical site infections (SSIs) by identifying patients at high risk for infectious complications, a better understanding of relevant risk factors is required. This manuscript describes a matched case-control study of patients undergoing cranial neurosurgery with postoperative surgical site infections and a systematic literature review. METHODS: From January 2012 to March 2015, 70 patients (2.47%) with SSIs (out of 2819 patients) and 185 controls were identified. Statistical analyses were performed using univariate and multivariate models to identify risk factors associated with SSIs. RESULTS: The time of the onset of SSIs ranged from 8 to 854 days after surgery (median: 42 days). American Society of Anesthesiologists score (P = 0.003), surgical drain (P < 0.001), number of previous operations (P < 0.001), and implantation of foreign material (P < 0.001) were significant risk factors for SSIs in multivariate analysis. In a systematic literature review, the authors identified 20 independent risk factors. CONCLUSIONS: This article provides information to ease the prospective assessment of patients at risk of SSI based on preoperative and postoperative risk factors. Lowering the incidence of SSIs will improve the patient outcomes and the overall quality of the healthcare delivered. To our knowledge, this is the first systemic literature review of SSIs in cranial neurosurgery and analysis of own cases in a wide spectrum.