Medical School, University of Michigan, Ann Arbor, MI, USA.
Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA.
Br J Neurosurg. 2024 Apr;38(2):503-509. doi: 10.1080/02688697.2021.1905773. Epub 2021 Mar 29.
Studies on surgical site infection (SSI) in adult neurosurgery have presented all subtypes of SSIs as the general 'SSI'. Given that SSIs constitute a broad range of infections, we hypothesized that clinical outcomes and management vary based on SSI subtype.
A retrospective analysis of all neurosurgical SSI from 2012-2019 was conducted at a tertiary care institution. SSI subtypes were categorized as deep and superficial incisional SSI, brain, dural or spinal abscesses, meningitis or ventriculitis, and osteomyelitis.
9620 craniotomy, shunt, and fusion procedures were studied. 147 procedures (1.5%) resulted in postoperative SSI. 87 (59.2%) of these were associated with craniotomy, 36 (24.5%) with spinal fusion, and 24 (16.3%) with ventricular shunting. Compared with superficial incisional primary SSI, rates of reoperation to treat SSI were highest for deep incisional primary SSI (91.2% vs 38.9% for superficial, < 0.001) and second-highest for intracranial SSI (90.9% vs 38.9%, = 0.0001). Postoperative meningitis was associated with the highest mortality rate (14.9%). Compared with superficial incisional SSI, the rate of readmission for intracranial SSI was highest (57.6% vs 16.7%, = 0.022).
Deep incisional and organ space SSI demonstrate a greater association with morbidity relative to superficial incisional SSI. Future studies should assess subtypes of SSI given these differences.
成人神经外科手术部位感染（SSI）的研究均将所有 SSI 亚型视为一般的“SSI”。鉴于 SSI 构成了广泛的感染，我们假设根据 SSI 亚型，临床结果和管理会有所不同。
在一家三级医疗机构对 2012 年至 2019 年所有神经外科 SSI 进行回顾性分析。SSI 亚型分为深部和浅部切口 SSI、脑脓肿、硬脑膜或脊髓脓肿、脑膜炎或脑室炎和骨髓炎。
研究了 9620 例开颅术、分流术和融合术。147 例（1.5%）术后发生 SSI。其中 87 例（59.2%）与开颅术相关，36 例（24.5%）与脊柱融合术相关，24 例（16.3%）与脑室分流术相关。与浅部切口原发性 SSI 相比，深部切口原发性 SSI 再手术治疗 SSI 的比例最高（91.2%比 38.9%， < 0.001），颅内 SSI 次之（90.9%比 38.9%， = 0.0001）。术后脑膜炎死亡率最高（14.9%）。与浅部切口 SSI 相比，颅内 SSI 的再入院率最高（57.6%比 16.7%， = 0.022）。
与浅部切口 SSI 相比，深部切口和器官间隙 SSI 与发病率的相关性更大。鉴于这些差异，未来的研究应评估 SSI 的亚型。
