Post-operative surgical site infections in Neurosurgery have high morbidity and mortality. World renowned Neurosurgical centres report an overall post-operative infection rate of about 2%.Various antibiotic regimes and aseptic precautions are recommended. We report our post-operative infection rate with aseptic procedures and antibiotic prophylaxis in our institute which is very economical and efficient. Among 524 cases, the distribution of the cases were as follows 33% (174/524) cranial, 53% (279/524) spinal, 6% (31/524) V-P shunt CSF diversion procedures, 7% (36/524) re-operated cases and 1% (7/524) endoscopic procedures. Immediate post-operative fever rates 2.2% (12/463), delayed post-op fever (>48 hours) rates 0.19% (1/463), CSF and blood culture positive rates 0.19% (1/463).Total incidence of post-operative infection is 0.19% and mortality due to post-operative infection is nil. Staph.aureus and Propionibacterium.acnes infections poses a threat in surgical procedures associated with a high risk of infection so antibiotic prophylaxis of the same can be effective in controlling SSI’s.
Surgical site infections (SSIs) are the most common and serious complications among surgically treated patients, resulting in increased rates of morbidity and mortality, prolonging stay in hospitals and costs. They are the third most commonly reported nosocomial infection and account for approximately a quarter of all nosocomial infections. Reported rates of SSIs are relatively variable, ranging from 1%-8% in published series after cranial surgery1 and from 0.5%-18.8% after spine surgery3. Such wide-ranging results from different reports may be caused by significant variations in operative factors, such as the use of implants or drains, the surgical approach itself and length of stay in hospital3,10. Up to 60% of SSIs are estimated to be preventable when using evidence-based guidelines2. Around 5–15% of Infection rate has been reported to occur in the shunt procedures done6,7. Many factors have been associated with shunt infection, are the aetiology of hydrocephalus, the age of the patient and the type of shunt implanted6. Although advances have been made in infection control pre- and peri-operative practices, including improved operating room ventilation, sterilization methods, surgical technique, barriers and availability of antimicrobial prophylaxis still SSIs continues to remain a substantial concern in Neurosurgery.
It is a retrospective analysis of all Neurosurgical cases operated by the department of Neurosurgery, Saveetha Medical College and Hospital, from the time of establishment May 2013- April 2017 with regard to post-operative infection rates and prevention strategies. The approval for conducting this study was obtained from the Institutional Ethics Committee prior to the study. In this study, we included all the cases operated by Neurosurgery department, since the inception. The incidence of post-operative infections and various factors influencing it were analysed in this study. The statistical analysis was performed using GraphPad software.
MATERIALS AND METHODS:
This study dates from 1st May 2013 to 30th April 2017, included 524 patients who have undergone neurosurgical procedures (cranial and spinal) both elective and emergency in the department of Neurosurgery. The incidence of post-operative fever,bone flap infections wound infections, meningitis, brain abscess and subdural empyema were recorded in these patients1. Patients were given a single dose of appropriate parental antibiotic pre-operatively and three doses post-operatively. All the cerebrospinal fluid cultures, blood cultures and wound swabs from the department were also analysed. Factors recorded were age,gender,co-morbid conditions, fever after 48 hours of surgery, raised WBC, raised ESR, duration of surgery, cranial/spinal surgery, elective/emergency surgery, wound site discharge, CSF and wound swab cultures, signs of meningitis12.
Among 527 cases, the distribution of the cases was as follows 33 % (174/527) cranial, 53% (279/527) spinal, 6% (31/527) V-P shunt CSF diversion procedures, 7% (36/527) re-operated cases and 1.3% (7/527) endoscopic procedures. Immediate post-operative fever rates 2.2% (12/527), delayed post-op fever (>48 hours) rate- 0.19% (1/527), CSF and blood culture positive rates 0.19% (1/524)(Graph 1).Total incidence of post-op infection is 0.19%, morbidity is 0.19% and mortality due to post-operative infection is nil. The mortality of SSI’s is around < 1% in most of the studies8,11.The one patient with post-op infection and fever after 48 hours (positive CSF and blood culture)(Table 1) was a re-do surgery for spinal dysraphism.