Consensus guidelines for infection reduction in deep brain stimulation surgery: A literature review and modified Delphi study

Background and objectives

Deep brain stimulation (DBS) has proven to be safe and effective in the treatment of certain movement disorders. Although the risk profile is low, surgical site infection (SSI) remains a common complication associated with DBS implantation. Currently, no standardized guidelines exist to minimize the risk of infection specific to DBS, and wide variability exists in the interventions used to limit SSI. This study aims to develop the first consensus-based guidelines to reduce the risk of infection in DBS implantation.

Methods

The Delphi technique was employed to establish best practices for perioperative care. A comprehensive literature review on methods to decrease SSI in DBS implantation was completed and shared with all practicing neurosurgeons in Washington state who perform adult DBS implantation. Based on the findings, two web-based surveys were developed and subsequently administered to the participants to discern the importance of specific SSI prevention methods in their practices.

Results

Nine neurosurgeons participated in the study. In the first round, the expert panel indicated interventions used in their practice. This yielded 18 items with high consensus, four items with moderate consensus, and zero items with no consensus. After a live expert panel discussion, the second survey resulted in five items with high consensus: preoperative chlorhexidine gluconate 4.0 % (CHG) showers, hemoglobin A1C target < 7.0, holding immunosuppressive medications, use of a linear incision, and postoperative wound checks.

Conclusion

This study presents the first consensus-based guidelines for infection prevention in DBS implantation, providing valuable recommendations that may help decrease infection rates and standardize practices.