Postoperative Intracranial Neurosurgery Infection Rates in North America Versus Europe: A Systematic Analysis


Shearwood McClelland III M.D.


Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN




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.



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.



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.



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.



Postoperative Wound Infection, Intracranial Neurosurgery, North America, Europe, Meta-analysis