Lekuya Hervé Monka, Vandersteene Jelle, Kamabu Larrey Kasereka, Nantambi Rose, Mbiine Ronald, Kirabira Anthony, Makumbi Fredrick, Cose Stephen, Kateete David Patrick, Kaddumukasa Mark, Baert Edward, Galukande Moses, Kalala Jean-Pierre Okito
Department of Surgery/Neurosurgery, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Human Structure and Repair/Neurosurgery UZ Gent, Ghent University, Ghent, Belgium.
Neurotrauma Rep. 2024 Sep 20;5(1):824-844. doi: 10.1089/neur.2024.0088. eCollection 2024.
Surgical site infections (SSIs) remain a major cause of life-threatening morbidity following surgery for depressed skull fractures (DSFs) among patients with traumatic brain injury (TBI). The timing of the surgery for DSF has been questioned as a risk of SSI without a clear cutoff. We aimed to compare the risk of SSI within 3 months between surgery done before versus after 48 h of injury and with its preoperative predictors. We conducted a prospective cohort study at Mulago Hospital, Uganda. Patients with mild-to-moderate TBI with DSF were followed up perioperatively from the operating time up to 3 months. The outcome variables were the incidence risk of SSI, types of SSI, microbial culture patterns of wound isolates, and hospital length of stay. We enrolled 127 patients with DSF, median age = 24 (interquartile range [IQR] = 17-31 years), 88.2% (112/127) male, and assault victims = 53.5%. The frontal bone involved 59%, while 50.4% had a dural tear. The incidence of SSI was 18.9%, mainly superficial incisional infection; Gram-negative microorganisms were the most common isolates (64.7%). The group of surgical intervention >48 h had an increased incidence of SSI (57.3% vs. 42.7%, = 0.006), a longer median of postoperative hospital stay (8[IQR = 6-12] days versus 5 [IQR = 4-9], [ < 0.001]), and a higher rate of reoperation (71.4% vs. 28.6%, = 0.05) in comparison with the group of ≤48 h. In multivariate analysis between the group of SSI and no SSI, surgical timing >48 h (95% confidence interval [CI], 1.25-6.22), pneumocranium on computed tomography [CT] scan (95% CI: 1.50-5.36), and involvement of air sinus (95% CI: 1.55-5.47) were associated with a >2.5-fold increase in the rate of SSI. The SSI group had a longer median hospital stay ( value <0.001). The SSI risk in DSF is high following a surgical intervention >48 h of injury, with predictors such as the frontal location of DSF, pneumocranium on a CT scan, and involvement of the air sinus. We recommend early surgical intervention within 48 h of injury.
手术部位感染（SSIs）仍然是创伤性脑损伤（TBI）患者颅骨凹陷性骨折（DSFs）手术后危及生命的发病的主要原因。DSF手术时机一直受到质疑，因为存在SSI风险且没有明确的截止时间。我们旨在比较受伤后48小时之前与之后进行手术的患者在3个月内发生SSI的风险及其术前预测因素。我们在乌干达穆拉戈医院进行了一项前瞻性队列研究。对患有轻度至中度TBI和DSF的患者从手术时间开始进行围手术期随访，直至3个月。结局变量包括SSI的发病风险、SSI类型、伤口分离株的微生物培养模式以及住院时间。我们纳入了127例DSF患者，中位年龄 = 24岁（四分位间距[IQR] = 17 - 31岁），男性占88.2%（112/127），袭击受害者占53.5%。额骨受累占59%，而50.4%有硬脑膜撕裂。SSI的发生率为18.9%，主要是浅表切口感染；革兰氏阴性微生物是最常见的分离株（64.7%）。与≤48小时组相比，手术干预>48小时组的SSI发生率增加（57.3%对42.7%，P = 0.006），术后住院中位时间更长（8[IQR = 6 - 12]天对5[IQR = 4 - 9]天，P < 0.001），再次手术率更高（71.4%对28.6%，P = 0.05）。在SSI组和非SSI组的多变量分析中，手术时机>48小时（95%置信区间[CI]，1.25 - 6.22）、计算机断层扫描[CT]上的气颅（95%CI：1.50 - 5.36）以及鼻窦受累（95%CI：1.55 - 5.47）与SSI发生率增加>2.5倍相关。SSI组的住院中位时间更长（P值<0.001）。受伤后>48小时进行手术干预后，DSF患者发生SSI的风险很高，其预测因素包括DSF的额部位置、CT扫描上的气颅以及鼻窦受累。我们建议在受伤后48小时内尽早进行手术干预。
