Introduction: Surgical site infection (SSI) is a common postoperative complication that increases postoperative morbidity and economic burden. As we move further towards value-based purchasing models, hospitals and physicians have been particularly interested in decreasing incidence of preventable complications such as SSI to ensure optimum patient outcomes and hence less reimbursement cuts. In this manuscript, we sought to investigate the differences between early (<30 days) and late (>30 days) SSI.
Methods: Patients undergoing neurosurgical procedure and having a subsequent diagnosis of SSI were abstracted from an institutional prospective database of SSI. Patient demographics, preoperative, perioperative and postoperative variables of interest were collected from medical records.
Results: A total of 335 patients fit the inclusion criteria. Two hundred and forty-three (72.5%) contracted SSI within the first 30 days of operation while 92 (27.5%) patients had an SSI after 30 days. More cranial patients were found to have a late SSI (76.1%, n= 70) vs early SSI (52.7%, n= 128), whereas spinal patients were more likely to have an early SSI (38.7%, n= 94 vs after 30 days 18.5%, n= 17, (OR: 0.29, 95% CI: 0.14 to 0.59, p<0.001). Older patients were found to be more likely to have an SSI after 30 days(OR: 1.03, 95% CI: 1.02 to 1.04, p<0.001). Gram negative organisms were associated with significantly more Early SSI (OR: 3.3 95% CI: 1.35 - 8.3, p=0.009).
Conclusions: Investigating the risk factors for SSI developing beyond 30 days time point can be critical to understand the pattern of SSI after neurosurgery and the factors implicated in the development of this preventable complication. We found that older patients, open surgery, cranial surgery and Gram positive bacteria as the causative pathogen were all associated with higher risks of developing surgical site infections beyond 30 days.
Patient Care: It contributes to the understanding of the pattern of SSI after neurosurgery and the factors implicated in the development of it beyond the fixed 30 days time-point set by healthcare quality surveillance programs. This valuable information can help in adequately managing and following patients with higher risks of early as well as late SSI development.
Learning Objectives: • The cutoff time points used in the surveillance of SSI in neurosurgery needs to be re-explored.
• Late SSI constitute large number of patients, a third (n=92) of neurosurgery cases in our cohort (n=335).
• Patient age, open surgery, cranial surgery and Gram positive bacteria are important factors for late SSI in neurosurgery.