[Influence of surgical access on bacterial contamination of autologous blood in neurosurgical patients].

All perioperative invasive procedures, including those associated with autologous blood circulation in extracorporeal circuit, should be considered as a risk factor of infectious complications. Despite perioperative antibiotic prophylaxis and compliance with standards for hardware reinfusion in neurosurgical interventions, bacterial contamination of autologous blood occurs in 38.3% of cases. One of the risk factors may be surgical approach.

Objective: To analyze the influence of surgical access on bacterial contamination of autologous blood and effectiveness of complex decontamination in hardware reinfusion in neurosurgery.

Material and methods: The study included 107 patients with CNS tumors and high risk of intraoperative blood loss with hardware blood reinfusion. Three surgical approaches were used: transcranial, extended transcranial with opening of paranasal sinuses and transnasal endoscopic access. The protocol of perioperative antibiotic prophylaxis was used in all patients. We evaluated bacterial contamination after decontamination using microbiological testing.

Results: Surgical approach significantly affected the risk of bacterial contamination of autologous blood in neurosurgical patients (p<0.001). The minimum risk was observed for transcranial approaches (29%), moderate - for extended transcranial approaches (50%), maximum - for transnasal endoscopic approaches (100%). This pattern is not presented in available literature. There were no local or systemic infectious complications in postoperative period.

Conclusion: Transfusion of autologous blood is quite safe in case of appropriate perioperative antibiotic prophylaxis and all measures aimed at blood decontamination. Approaches with opening the paranasal sinuses require 4-stage decontamination (cefuroxime+washing+leukofiltration+irradiation).