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Clin Neurol Neurosurg. 2014 May;120:41-4. doi: 10.1016/j.clineuro.2014.02.009. Epub 2014 Feb 25.

Lower complication rates for cranioplasty with peri-operative bundle.

Author information

1
University of California Los Angeles, Neurocritical Care Department, Los Angeles, USA.
2
Kaiser Sacramento Neurosurgery Department, 2025 Morse Avenue, Sacramento, 95825, USA.
3
Kaiser Surgical Implant Registry, 8954 Rio San Diego Drive, Suite 406, San Diego, 92108, USA.
4
Kaiser Sacramento Neurosurgery Department, 2025 Morse Avenue, Sacramento, 95825, USA. Electronic address: paul.t.akins@kp.org.

Abstract

BACKGROUND:

The overall benefits of craniectomy must include procedural risks from cranioplasty. Cranioplasty carries a high risk of surgical site infections (SSI) particularly with antibiotic resistant bacteria. The goal of this study was to measure the effect of a cranioplasty bundle on peri-operative complications.

METHODS:

The authors queried a prospective, inpatient neurosurgery database at Kaiser Sacramento Medical Center for craniectomy and cranioplasty over a 7 year period. 57 patients who underwent cranioplasties were identified. A retrospective chart review was completed for complications, including surgical complications such as SSI, wound dehiscence, and re-do cranioplasty. We measured cranioplasty complication rates before and after implementation of a peri-operative bundle, which consisted of peri-operative vancomycin (4 doses), a barrier dressing through post-operative day (POD) 3, and de-colonization of the surgical incision using topical chlorhexidine from POD 4 to 7.

RESULTS:

The rate of MRSA colonization in cranioplasty patients is three times higher than the average seen on ICU admission screening (19% vs. 6%). The cranioplasty surgical complication rate was 22.8% and SSI rate was 10.5%. The concurrent SSI rate for craniectomy was 1.9%. Organisms isolated were methicillin-resistant Staphylococcus aureus (4), methicillin-sensitive S. aureus (1), Propionibacterium acnes (1), and Escherichia coli (1). Factors associated with SSI were peri-operative vancomycin (68.6% vs. 16.7%, p=0.0217). Complication rates without (n=21) and with (n=36) the bundle were: SSI (23.8% vs. 2.8%, p=0.0217) and redo cranioplasty (19% vs. 0%, p=0.0152). Bundle use did not affect rates for superficial wound dehiscence, seizures, or hydrocephalus.

CONCLUSIONS:

The cranioplasty bundle was associated with reduced SSI rates and the need for re-do cranioplasties.

KEYWORDS:

Care bundles; Craniectomy; Cranioplasty; MRSA infection; Surgical site infection

PMID:
24731574
DOI:
10.1016/j.clineuro.2014.02.009
[Indexed for MEDLINE]

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