Timing of Surgery and Preoperative Predictors of Surgical Site Infections for Patients with Depressed Skull Fractures in a Sub-Saharan Tertiary Hospital: A Prospective Cohort Study.

IF 1.8 Q3 CLINICAL NEUROLOGY
Neurotrauma reports Pub Date : 2024-09-20 eCollection Date: 2024-01-01 DOI:10.1089/neur.2024.0088
Hervé Monka Lekuya, Jelle Vandersteene, Larrey Kasereka Kamabu, Rose Nantambi, Ronald Mbiine, Anthony Kirabira, Fredrick Makumbi, Stephen Cose, David Patrick Kateete, Mark Kaddumukasa, Edward Baert, Moses Galukande, Jean-Pierre Okito Kalala
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引用次数: 0

Abstract

Surgical site infections (SSIs) remain a major cause of life-threatening morbidity following surgery for depressed skull fractures (DSFs) among patients with traumatic brain injury (TBI). The timing of the surgery for DSF has been questioned as a risk of SSI without a clear cutoff. We aimed to compare the risk of SSI within 3 months between surgery done before versus after 48 h of injury and with its preoperative predictors. We conducted a prospective cohort study at Mulago Hospital, Uganda. Patients with mild-to-moderate TBI with DSF were followed up perioperatively from the operating time up to 3 months. The outcome variables were the incidence risk of SSI, types of SSI, microbial culture patterns of wound isolates, and hospital length of stay. We enrolled 127 patients with DSF, median age = 24 (interquartile range [IQR] = 17-31 years), 88.2% (112/127) male, and assault victims = 53.5%. The frontal bone involved 59%, while 50.4% had a dural tear. The incidence of SSI was 18.9%, mainly superficial incisional infection; Gram-negative microorganisms were the most common isolates (64.7%). The group of surgical intervention >48 h had an increased incidence of SSI (57.3% vs. 42.7%, p = 0.006), a longer median of postoperative hospital stay (8[IQR = 6-12] days versus 5 [IQR = 4-9], [p < 0.001]), and a higher rate of reoperation (71.4% vs. 28.6%, p = 0.05) in comparison with the group of ≤48 h. In multivariate analysis between the group of SSI and no SSI, surgical timing >48 h (95% confidence interval [CI], 1.25-6.22), pneumocranium on computed tomography [CT] scan (95% CI: 1.50-5.36), and involvement of air sinus (95% CI: 1.55-5.47) were associated with a >2.5-fold increase in the rate of SSI. The SSI group had a longer median hospital stay (p value <0.001). The SSI risk in DSF is high following a surgical intervention >48 h of injury, with predictors such as the frontal location of DSF, pneumocranium on a CT scan, and involvement of the air sinus. We recommend early surgical intervention within 48 h of injury.

撒哈拉以南地区一家三级医院中凹陷性颅骨骨折患者的手术时机和手术部位感染的术前预测因素:前瞻性队列研究
手术部位感染(SSI)仍然是脑外伤(TBI)患者颅骨凹陷性骨折(DSF)手术后危及生命的主要发病原因。颅骨凹陷骨折手术的时机一直被质疑为 SSI 风险的一个因素,但没有一个明确的分界线。我们的目的是比较受伤 48 小时前和受伤 48 小时后进行手术的患者在 3 个月内发生 SSI 的风险及其术前预测因素。我们在乌干达穆拉戈医院开展了一项前瞻性队列研究。对轻度至中度创伤性脑损伤并伴有DSF的患者进行了从手术开始到3个月的围手术期随访。研究结果变量包括 SSI 的发生风险、SSI 的类型、伤口分离物的微生物培养模式以及住院时间。我们共收治了127名DSF患者,中位年龄=24岁(四分位距[IQR]=17-31岁),88.2%(112/127)为男性,袭击受害者=53.5%。59%的患者伤及额骨,50.4%的患者硬膜撕裂。SSI 发生率为 18.9%,主要是切口表皮感染;革兰氏阴性微生物是最常见的分离菌(64.7%)。与手术时间≤48 小时组相比,手术时间≥48 小时组的 SSI 发生率更高(57.3% 对 42.7%,P = 0.006),术后住院时间中位数更长(8[IQR = 6-12] 天对 5 [IQR = 4-9] 天,[P < 0.001]),再次手术率更高(71.4% 对 28.6%,P = 0.05)。在 SSI 组与无 SSI 组的多变量分析中,手术时间 >48 小时(95% 置信区间 [CI],1.25-6.22)、计算机断层扫描 [CT] 扫描显示气颅(95% CI:1.50-5.36)和气窦受累(95% CI:1.55-5.47)与 SSI 发生率增加 2.5 倍以上相关。SSI 组的中位住院时间较长(P 值为受伤 48 小时,预测因素包括 DSF 的前额位置、CT 扫描显示的气颅和气窦受累。我们建议在受伤 48 小时内尽早进行手术治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.40
自引率
0.00%
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审稿时长
8 weeks
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