Lower complication rates for cranioplasty with pen-operative bundle

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 pen-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 pen-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 pen-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. (C) 2014 Elsevier B.V. All rights reserved.