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Neurosurgical infection rates

Panagiotis Kerezoudis, Amy E Glasgow, Mohammed Ali Alvi, Robert J Spinner, Fredric B Meyer, Mohamad Bydon, Elizabeth B Habermann
BACKGROUND: Return to the operating room (ROR) has been put forth by the National Quality Forum and the American College of Surgeons as a surgical quality indicator. However, current quality metrics fail to consider the nature and etiology of the ROR. OBJECTIVE: To provide a comprehensive description of all reoperations after neurosurgical procedures and assess the validity of ROR as a quality measure in neurosurgery. METHODS: We retrospectively analyzed all neurosurgical procedures performed in a high-volume, tertiary care academic medical center between June 1, 2014 and December 31, 2016...
October 8, 2018: Neurosurgery
Felicia Chow
PURPOSE OF REVIEW: Brain abscesses and spinal epidural abscesses are serious, potentially life-threatening infections of the central nervous system. This article outlines the clinical presentation, evaluation, and management of brain abscesses and spinal epidural abscesses, with a specific focus on bacterial infections. RECENT FINDINGS: The overall incidence of brain abscesses has declined, in part because of fewer brain abscesses associated with otogenic infections...
October 2018: Continuum: Lifelong Learning in Neurology
Ahmed E Helal, Heba Abouzahra, Ahmed Abdelaziz Fayed, Tarek Rayan, Mahmoud Abbassy
Healthcare spending has become a grave concern to national budgets worldwide, and to a greater extent in low-income countries. Brain tumors are a serious disease that affects a significant percentage of the population, and thus proper allocation of healthcare provisions for these patients to achieve acceptable outcomes is a must. The authors reviewed patients undergoing craniotomy for tumor resection at their institution for the preceding 3 months. All the methods used for preoperative planning, intraoperative management, and postoperative care of these patients were documented...
October 2018: Neurosurgical Focus
Tae Seok Jeong, Gi Taek Yee
OBJECTIVE: This study aimed to investigate the rates, types, and risk factors of surgical site infection (SSI) following intracranial neurosurgical procedures evaluated by a Korean SSI surveillance system. METHODS: This was a prospective observational study of patients who underwent neurosurgical procedures at 29 hospitals in South Korea from January 2017 to June 2017. The procedures included craniectomy, craniotomy, cranioplasty, burr hole, and ventriculoperitoneal shunt...
September 2018: Journal of Korean Neurosurgical Society
Allen L Ho, John G D Cannon, Jyodi Mohole, Arjun V Pendharkar, Eric S Sussman, Gordon Li, Michael S B Edwards, Samuel H Cheshier, Gerald A Grant
OBJECTIVE Topical antimicrobial compounds are safe and can reduce cost and complications associated with surgical site infections (SSIs). Topical vancomycin has been an effective tool for reducing SSIs following routine neurosurgical procedures in the spine and following adult craniotomies. However, widespread adoption within the pediatric neurosurgical community has not yet occurred, and there are no studies to report on the safety and efficacy of this intervention. The authors present the first institution-wide study of topical vancomycin following open craniotomy in the pediatric population...
August 24, 2018: Journal of Neurosurgery. Pediatrics
Ankush Gupta, Reman Ramesh Nair, Ranjith K Moorthy, Vedantam Rajshekhar
OBJECTIVE: To study the effect of a staphylococcal decolonization regimen (SDR) and change in antibiotic prophylaxis regimen on postoperative meningitis (bacterial and aseptic) rates in patients undergoing elective cranial surgery. METHODS: Data on elective craniotomy (supratentorial and infratentorial) were collected retrospectively for a total of 4 years-2 years before (2011-2012; group A) and 2 years after (2014-2015; group B) initiation of a SDR and a change in the antibiotic prophylaxis regimen (from chloramphenicol to ceftriaxone) in a neurosurgical unit of a tertiary care hospital...
August 1, 2018: World Neurosurgery
Nicholas J Goel, Arka N Mallela, Prateek Agarwal, Kalil G Abdullah, Omar A Choudhri, David K Kung, Timothy H Lucas, H Isaac Chen
OBJECTIVE: The objective of this study was to assess the independent effect of complications on 30-day mortality in 32,695 patients undergoing elective craniotomy. METHODS: The American College of Surgeons National Surgical Quality Improvement Program was queried for patients undergoing elective craniotomy from 2006 to 2015. Multivariate logistic regression was used to examine the effect of complications on mortality independent of preoperative risk and other postoperative complications...
October 2018: World Neurosurgery
John G D Cannon, Allen L Ho, Jyodi Mohole, Arjun V Pendharkar, Eric S Sussman, Samuel H Cheshier, Gerald A Grant
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To determine if topical vancomycin irrigation reduces the incidence of post-operative surgical site infections following pediatric spinal procedures. Surgical site infections (SSIs) following spinal procedures performed in pediatric patients represent a serious complication. Prophylactic use of topical vancomycin prior to closure has been shown to be effective in reducing incidence of SSIs in adult spinal procedures...
June 28, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Alejandro Enriquez-Marulanda, Luis C Ascanio, Mohamed M Salem, Georgios A Maragkos, Ray Jhun, Abdulrahman Y Alturki, Justin M Moore, Christopher S Ogilvy, Ajith J Thomas
BACKGROUND: In the current dynamic health environment, increasing number of procedures are being completed by advanced practitioners (nurse practitioners and physician assistants). This is the first study to assess the clinical outcomes and safety of external ventricular drain (EVD) placements by specially trained advanced practitioners. OBJECTIVE: Compare the safety and outcomes of EVD placement by advanced practitioners in patients with subarachnoid hemorrhage (SAH)...
June 11, 2018: Neurocritical Care
Andreas Leidinger, Jose Piquer, Eliana E Kim, Hadia Nahonda, Mahmood M Qureshi, Paul H Young
BACKGROUND: Pediatric hydrocephalus is a health burden for East African countries, with an estimated incidence of 6000 new cases per year. The objective of this study is to describe the epidemiology and surgical outcomes of patients treated for pediatric hydrocephalus in the single neurosurgical center of Zanzibar. METHODS: From December 2016 to December 2017, we prospectively collected data on all patients admitted with the diagnosis of hydrocephalus. Information was gathered regarding demographics, maternal health, preoperative imaging, surgical procedures, and postsurgical complications...
September 2018: World Neurosurgery
Pablo David Guerrero-Suarez, Paola Guerrero-López, Abarin Ortiz-Leon, Haydee Samantha Sosa-Castillo, Lenny Marlene Velazquez-Gonzalez, Jaime Jesus Martinez-Anda
Decompressive craniectomy is an urgent procedure that is increasingly used for treatment of intracranial hypertension. After recovery, reconstruction of the cranial defect is necessary. Cranioplasty is an elective procedure with a high potential for morbidity if care is not taken on different surgical factors such as the material used as the cranial flap. In Latin America, high costs in some materials used in cranioplasty make its use prohibitive for some patients and institutions, and looking for alternatives has become a priority in neurosurgical centers...
September 2018: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Gabriel F Santiago, Jordan Terner, Amir Wolff, Jeffrey Teixeira, Henry Brem, Judy Huang, Chad R Gordon
INTRODUCTION: An irregular craniofacial contour along the temporal fossa, known commonly as 'temporal hollowing deformity,' (THD) can arise from multiple etiologies. In fact, up to half of all patients who undergo neurosurgical pterional dissections develop some form of temporal contour deformities. Unfortunately, temporal hollowing correction remains surgically challenging with many techniques resulting in high rates of failure and/or morbidity. METHODS: Herein, we describe anatomy contributing to postsurgical temporal deformity as well as time-tested prevention and surgical correction techniques...
October 2018: Journal of Craniofacial Surgery
Oliver D Mrowczynski, Sara T Langan, Elias B Rizk
Central nervous system infections can be complications of neurosurgical procedures or can occur spontaneously, and occasionally lead to devastating neurological complications, increased rate of mortality, and lengthier stays in the hospital, subsequently increasing costs. The use of intrathecal antibiotics to bypass the blood brain barrier and provide effective concentrations to the central nervous system has been described as an adjunct treatment option. However, the regimens of antibiotics utilized intrathecally have not been standardized...
July 2018: Clinical Neurology and Neurosurgery
Vikas Kotagal, Elizabeth Walkowiak, Jason A Heth
OBJECTIVE: Recent Normal Pressure Hydrocephalus (NPH) practice guidelines describe a serious adverse event (SAE) rate following surgery of 11%. PATIENTS & METHODS: We conducted a retrospective review of 162 consecutive patients who have undergone work-up at our center's multidisciplinary NPH clinic over a 47 month time period (2/2014-12/2017). Of these, 22 ultimately underwent neurosurgical ventricular shunt surgery as treatment for NPH. Clinical records were reviewed for SAEs categorized as possibly/probably/definitely related to NPH surgery...
July 2018: Clinical Neurology and Neurosurgery
Luis Zapata, Ernest J Wright, Peter Nakaji
BACKGROUND: The neurosurgical literature rarely describes managing open head injuries caused by machetes, although this is a common head injury in developing countries. We present our experience managing cranial machete injuries in Nicaragua over a 5-year period. METHODS: A retrospective chart review identified patients admitted to a neurosurgery service for cranial machete injury. RESULTS: Among 51 patients studied, the majority (n = 42, 82%) presented with mild neurologic deficits (Glasgow Coma Scale score ≥14)...
August 2018: World Neurosurgery
Marjut Westman, Harri Marttila, Melissa Rahi, Esa Rintala, Eliisa Löyttyniemi, Tuija Ikonen
WHO surgical safety checklist has been proven to reduce postoperative infections in several studies. The aim of our study was to focus on surgical site infections (SSIs) after neurosurgical operations, and to determine whether the checklist implementation would have an impact on the reported SSIs. We used hospital-acquired infection (HAI) register to evaluate the effects of WHO surgical safety checklist in neurosurgery. The HAI register was searched for superficial and deep SSIs, deep organ SSIs, infections following orthopaedic implantation, and other surgical infections of 4678 neurosurgical patients operated on between 2007 and 2011...
July 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Tommi K Korhonen, Sami Tetri, Jukka Huttunen, Antti Lindgren, Jaakko M Piitulainen, Willy Serlo, Pekka K Vallittu, Jussi P Posti
OBJECTIVE Craniectomy is a common neurosurgical procedure that reduces intracranial pressure, but survival necessitates cranioplasty at a later stage, after recovery from the primary insult. Complications such as infection and resorption of the autologous bone flap are common. The risk factors for complications and subsequent bone flap removal are unclear. The aim of this multicenter, retrospective study was to evaluate the factors affecting the outcome of primary autologous cranioplasty, with special emphasis on bone flap resorption...
May 11, 2018: Journal of Neurosurgery
Jonathan Dallas, Katherine D Sborov, Bradley S Guidry, Silky Chotai, Christopher M Bonfield
OBJECTIVE Many patients undergoing spinal fusion for neuromuscular scoliosis have preexisting neurosurgical implants, including ventricular shunts (VSs) for hydrocephalus and baclofen pumps (BPs) for spastic cerebral palsy. Recent studies have discussed a possible increase in implant complication rates following spinal fusion, but published data are inconclusive. The authors therefore, sought to investigate: 1) the rate of implant complications following fusion, 2) possible causes of these complications, and 3) factors that place patients at higher risk for implant-related complications...
July 2018: Journal of Neurosurgery. Pediatrics
Paul T Akins, Brian Jian
Initially reported in tropical regions, Cryptococcus gattii infection is now diagnosed globally. METHODS: case report; Literature review. Although initial reports described outbreaks of pulmonary and central nervous system (CNS) disease in tropical regions such as Australia and New Guinea, it is now clear that Cryptococcus gattii is a global, neurotropic pathogen. In contrast with C. neoformans, C. gattii patients are more likely to present with cryptococcomas in the brain and lungs and are often HIV negative...
April 16, 2018: Neurocritical Care
Andreea Seicean, Prateek Kumar, Sinziana Seicean, Duncan Neuhauser, Warren R Selman, Nicholas C Bambakidis
OBJECTIVE: There is conflicting and limited literature on the effect of intraoperative resident involvement on surgical outcomes. Our study assessed effects of resident involvement on outcomes in patients undergoing neurosurgery. METHODS: We identified 33,977 adult neurosurgical cases from 374 hospitals in the 2006-2012 National Surgical Quality Improvement Program, a prospectively collected national database with established reproducibility and validity. Outcomes were compared according to resident involvement before and after 1:1 matching on procedure and perioperative risk factors...
March 2018: Neurospine
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