Introduction: Surgical site infections (SSIs) are an important cause of morbidity in patients undergoing craniotomy or craniectomy for evacuation of post-traumatic intracranial hematoma. We sought to review the rate of SSI and examine characteristics of these infections in a consecutive series.
Methods: We retrospectively reviewed all patients undergoing emergency craniotomy or craniectomy for traumatic brain injury between July 2008 and September 2010. Patient demographics, radiographic data, laboratory values, hospital course, and clinical outcomes information were reviewed. The vast majority of patients were treated with perioperative cefazolin. Fisher exact test was used to examine categorical variables. Mann-Whitney U test was used for continuous variables after demonstrating non-normality of data.
Results: A total of 181 patients were identified in the two-year period of the study. Four SSIs were identified, yielding an infection rate of 2.2%. Wound washouts occurred a median of 17 days after the initial surgery (range 12-36 days). Cultures were positive for Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter calcoaceticus-baumannii complex, and Staphylococcus epidermidis. Operative times were similar in patients who had SSIs (2:31) and those who did not (2:25). There was a trend towards an association between SSI and any positive blood, urine, or respiratory culture (4.2% of those with any positive systemic culture vs. 0% of those without, p = 0.12). There was a trend towards longer hospital stay in patients with SSI (median 22.5 vs. 11 days, p=0.052). Age, race, and gender were not associated with SSI.
Conclusions: Over a two-year period, the rate of SSI after craniotomy or craniectomy for evacuation of traumatic intracranial hemorrhage at our institution was 2.2%. No association was found between SSI and potential factors, likely owing to small number of events.
Patient Care: Knowledge regarding surgical site infections will improve care and prevent post-surgical morbidity in patients who undergo craniotomy or craniectomy for traumatic brain injury.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) State the rate of surgical site infection in patients after surgery for traumatic cranial injury in this series
2) State factors possibly relating to surgical site infections in this series
3) State factors not related to surgical site infections in this series