Introduction: Postoperative infection is a significant cause of morbidity and mortality in traumatic brain injury (TBI) patients who undergo craniotomy and/or craniectomy. Data on the rates of infections associated with these procedures are limited. We present a single-center retrospective study on the rates of infection in post-traumatic craniotomies, craniectomies and cranioplasties.
Methods: Data on 247 TBI adult patients who underwent a craniotomy, craniectomy and/or cranioplasty from 2010-2015 were analyzed. Demographic and perioperative data including open/closed TBI, peri/postoperative infections, duration of procedure, type and mode of bone flap preservation were retrieved.
Results: From our preliminary results of 131 severe brain injury (GCS <9) patients (74% male and 26% female) so far reviewed, two-thirds presented with acute subdural hematomas, while the remainder had epidural hematomas or stroke. 60% underwent craniotomy. Of the 40% that had a craniectomy procedure, 67% underwent subsequent cranioplasty. The overall risk of infection following craniotomy,craniectomy and/or cranioplasty was 8%. The overall mortality rate from all causes was 12%.
Conclusions: The results of this study emphasize the need for instituting robust perioperative protocols to reduce infections. Further research is currently being pursued as following this study to establish a protocol similar to the Hydrocephalus Clinical Research Network’s (HCRN) ventriculoperitoneal shunt (VP) protocol, in an attempt to reduce perioperative infection rates. Our projection is based on the protocol’s 3.15% absolute risk reduction of VP shunt infections.
Patient Care: Identification of modifiable factors that increase the risk of infection following severe brain injury surgery would direct the establishment of protocols aimed at reducing preventable brain injury-related morbidity and mortality.
Learning Objectives: 1)Recognize modifiable factors for reducing the risk of postoperative infection following craniotomy/craniectomy/cranioplasty procedures in brain injury patients
2) Appreciate the role of multi-center infection control protocols in reducing postoperative infections
3) Identify the differences in postoperative outcomes between craniotomy and craniectomy procedures for severe brain injury patients