Risk factors of neurosurgical site infection after craniotomy: A systematic review and meta-analysis

• Published in: American journal of infection control 2017-11, Vol.45 (11), p.e123-e134
• Main Authors: Fang, Chenyan, Zhu, Tao, Zhang, Ping, Xia, Liang, Sun, Caixing
• Format: Article
• Language: English
• Subjects: Craniotomy; Craniotomy - adverse effects; Humans; Intracranial infection; Meta-analysis; Neurosurgical Procedures - adverse effects; Risk Factors; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2017.06.009

•This meta-analysis provides new evidence of risk factors of neurosurgical site infection (SSI).•There were 9 risk factors related to SSI, such as cerebrospinal fluid leakage (CSF) and so forth.•The risk of CSF leakage for SSI was the highest. Neurosurgical site infection (SSI) is a complication related to craniotomy, which may lead to severe morbidity and higher hospital costs during the postoperative period. Retrospective cohorts, case-control studies, or prospective investigations addressing risk factors of SSI updated until January 2017 were systematically searched in 2 databases (PubMed and Embase). The Newcastle-Ottawa Scale was used to evaluate quality of the included studies, heterogeneity was assessed by I2 tests, and a funnel plot and Egger test were used for the evaluation of publication bias. There were 26 studies in total enrolled in this review. The results showed that the risk factors which had relation with SSI were other infection (odds ratio [OR], 5.42; 95% confidence interval [CI], 2.8-10.49), number of operations (>1) (OR, 2.352; 95% CI, 1.142-4.847), cerebrospinal fluid (CSF) leak (OR, 7.817; 95% CI, 2.573-23.751), CSF drainage (OR, 2.55; 95% CI, 1.58-4.11), duration of operation (>4 hours) (as for retrospective cohort studies) (OR, 1.766; 95% CI, 1.110-2.809), venous sinus entry (OR, 4.015; 95% CI, 1.468-10.982), American Society of Anesthesiologists score (>2) (OR, 1.398; 95% CI, 1.098-1.78), sex (male) (as for prospective investigations) (OR, 1.474; 95% CI, 1.013-2.145), and surgical reasons (nontraumatic) (OR, 2.137; 95% CI, 1.106-4.129). According to the current analysis, all the factors mentioned were the risk factors for SSI after craniotomy. Patients with these risk factors should be paid more attention to prevent SSI. More evidence provided by high-quality studies is still needed to further investigate the risk factors of SSI.