Postoperative Intracranial
Neurosurgery Infection Rates in North America Versus Europe: A Systematic
Analysis
Department of Neurosurgery, University of Minnesota
Medical School, Minneapolis, MN
Introduction:
Postoperative
wound infection (PWI) following intracranial neurosurgery remains a significant
worldwide problem, resulting in substantial morbidity/mortality if not combated
quickly and energetically.
Although the danger of PWI is universally recognized, the reported incidence
of PWI following intracranial neurosurgery remains variable, ranging from 1-8%
in published series. Due to
differences in patient populations and neurosurgical management emphasis,
different geographic regions may experience differing rates of PWI following
intracranial neurosurgery. To
address this issue, the following review was performed of published
comprehensive intracranial neurosurgery series, segregating findings
geographically between North American and European series.
Methods:
A
comprehensive literature search was performed using the Entrez gateway of the
PubMed database. Studies conducted
in North America and Europe reporting the incidence of PWI following
intracranial neurosurgery were subjected to a thorough review. Data from studies meeting inclusion
criteria (minimum 500 cases with no systematic exclusion of procedures) was
categorized by origin (North American/European) and design
(retrospective/prospective).
Recorded incidences were then compared using chi-square analysis, and
estimates of the relative risk of PWI were calculated.
Results:
Seven
studies met all inclusion criteria (four North American, three European), with
the incidence of PWI 2.6 times higher in European studies (P<0.001). The relative risk of PWI for Europeans
versus North Americans per operative case was 2.60.
Conclusion:
PWI following intracranial neurosurgery was nearly three times more
likely in European versus North American studies. These findings should be considered by clinicians when
estimating the risks of intracranial neurosurgery, and may require
re-evaluation of infection prophylaxis protocols in neurosurgical patients.
Keywords:
Postoperative Wound Infection,
Intracranial Neurosurgery, North America, Europe, Meta-analysis