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Risk factors for surgical site infection in pediatric posterior fossa tumors

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Abstract

Purpose

Posterior fossa tumors are the most frequent pediatric solid tumor. Its main treatment is a surgical resection. Being a frequent procedure does not mean that it is exempt from complications, such as surgical site infections (SSI). The main objective of this paper is to study the risk factors associated with SSI following a resection of posterior fossa tumors in a purely pediatric population.

Methods

A retrospective case–control study including all posterior fossa tumor surgeries performed at our hospital between January 2014 and December 2019 was conducted. All patients with a diagnosis of a postoperative SSI have been included as cases, and those who had surgery and no infectious complications have been considered as controls.

Results

When analyzing risk factors, we have found that patients with ventriculoperitoneal shunt (VPS) (p = 0.03) or external ventricular drainage (EVD) (p = 0.005) placement had a greater chance of presenting a postoperative surgical site infection. Prolonged operative time (p < 0.001) and cerebrospinal fluid (CSF) leak through the wound (p = 0.002) also caused an increase in the risk of SSI in the postoperative period. A higher hemoglobin value (p = 0.002) would seem to be a preventive factor.

Conclusions

Some strategies that could help to reduce the risk of infections are managing hydrocephalus preferably with endoscopic third ventriculostomy, minimizing the needed operative time to perform the procedure, obtaining an adequate serum hemoglobin level, and avoiding CSF leak through the wound. 

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Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Muzumdar D, Ventureyra ECG (2010) Treatment of posterior fossa tumors in children. Expert Rev Neurother 10:525–546. https://doi.org/10.1586/ern.10.28

    Article  PubMed  Google Scholar 

  2. Brandão LA, Young Poussaint T (2017) Posterior fossa tumors. Neuroimaging Clin N Am 27:1–37. https://doi.org/10.1016/j.nic.2016.08.001

    Article  PubMed  Google Scholar 

  3. Spennato P, Nicosia G, Quaglietta L et al (2015) Posterior fossa tumors in infants and neonates. Childs Nerv Syst 31:1751–1772. https://doi.org/10.1007/s00381-015-2783-6

    Article  PubMed  Google Scholar 

  4. Shi Z-H, Xu M, Wang Y-Z et al (2017) Post-craniotomy intracranial infection in patients with brain tumors: a retrospective analysis of 5723 consecutive patients. Br J Neurosurg 31:5–9. https://doi.org/10.1080/02688697.2016.1253827

    Article  PubMed  Google Scholar 

  5. Santamarta D, Blázquez JA, Maillo A et al (2003) Analysis of cerebrospinal fluid related complications (hydrocephalus, fistula, pseudomeningocele and infection) following surgery for posterior fossa tumors. Neurocirugia 14:117–126. https://doi.org/10.1016/s1130-1473(03)70548-x

    Article  CAS  PubMed  Google Scholar 

  6. Sullivan E, Gupta A, Cook CH (2017) Cost and consequences of surgical site infections: a call to arms. Surg Infect 18:451–454. https://doi.org/10.1089/sur.2017.072

    Article  Google Scholar 

  7. Herrick DB, Tanenbaum JE, Mankarious M et al (2018) The relationship between surgical site drains and reoperation for wound-related complications following posterior cervical spine surgery: a multicenter retrospective study. J Neurosurg Spine 29:628–634. https://doi.org/10.3171/2018.5.SPINE171313

    Article  PubMed  Google Scholar 

  8. López Pereira P, Díaz-Agero Pérez C, López Fresneña N et al (2017) Epidemiology of surgical site infection in a neurosurgery department. Br J Neurosurg 31:10–15. https://doi.org/10.1080/02688697.2016.1260687

    Article  PubMed  Google Scholar 

  9. Dyall BAR, Schmökel HG (2018) Surgical site infection rate after hemilaminectomy and laminectomy in dogs without perioperative antibiotic therapy. Vet Comp Orthop Traumatol 31:202–213. https://doi.org/10.1055/s-0038-1639365

    Article  PubMed  Google Scholar 

  10. Yin D, Liu B, Chang Y et al (2018) Management of late-onset deep surgical site infection after instrumented spinal surgery. BMC Surg 18:121. https://doi.org/10.1186/s12893-018-0458-4

    Article  PubMed  PubMed Central  Google Scholar 

  11. Anderson PA, Savage JW, Vaccaro AR et al (2017) Prevention of Surgical Site Infection in Spine Surgery. Neurosurg 80:S114–S123. https://doi.org/10.1093/neuros/nyw066

    Article  Google Scholar 

  12. Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36:309–332. https://doi.org/10.1016/j.ajic.2008.03.002

    Article  PubMed  Google Scholar 

  13. Doyle DJ, Garmon EH (2019) American Society of Anesthesiologists classification (ASA class). StatPearls [Internet]

  14. Graves N, Halton K, Doidge S et al (2008) Who bears the cost of healthcare-acquired surgical site infection? J Hosp Infect 69:274–282. https://doi.org/10.1016/j.jhin.2008.04.022

    Article  CAS  PubMed  Google Scholar 

  15. Graf K, Ott E, Vonberg R-P et al (2011) Surgical site infections–economic consequences for the health care system. Langenbecks Arch Surg 396:453–459. https://doi.org/10.1007/s00423-011-0772-0

    Article  PubMed  Google Scholar 

  16. Bianchi F, Tamburrini G (2018) Posterior cranial fossa and spinal local infections. Childs Nerv Syst 34:1889–1892. https://doi.org/10.1007/s00381-018-3796-8

    Article  PubMed  Google Scholar 

  17. Vicencio AG (2010) Susceptibility to bronchiolitis in infants. Curr Opin Pediatr 22:302–306. https://doi.org/10.1097/MOP.0b013e32833797f9

    Article  PubMed  Google Scholar 

  18. Sutter DE, Milburn E, Chukwuma U et al (2016) Changing susceptibility of Staphylococcus aureus in a US pediatric population. Pediatrics 137. https://doi.org/10.1542/peds.2015-3099

  19. Michels KR, Lambrecht NJ, Carson WF et al (2019) The role of iron in the susceptibility of neonatal mice to Escherichia coli K1 Sepsis. J Infect Dis 220:1219–1229. https://doi.org/10.1093/infdis/jiz282

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Knight T, Glaser DW, Ching N, Melish M (2019) Antibiotic susceptibility of bloodstream isolates in a pediatric oncology population: the case for ongoing unit-specific surveillance. J Pediatr Hematol Oncol 41:e271–e276. https://doi.org/10.1097/MPH.0000000000001498

    Article  CAS  PubMed  Google Scholar 

  21. Dubey A, Sung W-S, Shaya M et al (2009) Complications of posterior cranial fossa surgery–an institutional experience of 500 patients. Surg Neurol 72:369–375. https://doi.org/10.1016/j.surneu.2009.04.001

    Article  PubMed  Google Scholar 

  22. Patir R, Mahapatra AK, Banerji AK (1992) Risk factors in postoperative neurosurgical infection. A prospective study Acta Neurochir 119:80–84. https://doi.org/10.1007/BF01541786

    Article  CAS  PubMed  Google Scholar 

  23. Cheng H, Chen BP-H, Soleas IM et al (2017) Prolonged operative duration increases risk of surgical site infections: a systematic review. Surg Infect 18:722–735. https://doi.org/10.1089/sur.2017.089

    Article  Google Scholar 

  24. Fang C, Zhu T, Zhang P et al (2017) Risk factors of neurosurgical site infection after craniotomy: a systematic review and meta-analysis. Am J Infect Control 45:e123–e134. https://doi.org/10.1016/j.ajic.2017.06.009

    Article  PubMed  Google Scholar 

  25. Golebiowski A, Drewes C, Gulati S et al (2015) Is duration of surgery a risk factor for extracranial complications and surgical site infections after intracranial tumor operations? Acta Neurochir 157:235–40; discussion 240. https://doi.org/10.1007/s00701-014-2286-3

  26. Gnanalingham KK, Lafuente J, Thompson D et al (2002) Surgical procedures for posterior fossa tumors in children: does craniotomy lead to fewer complications than craniectomy? J Neurosurg 97:821–826. https://doi.org/10.3171/jns.2002.97.4.0821

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Neurosurgery Department, Juan P. Garrahan Children’s Hospital, Buenos Aires, Argentina

    Amparo Sáenz, Eugenia Badaloni, Miguel Grijalba, Romina Argañaraz & Beatriz Mantese

  2. Facultad de Medicina LINT , Universidad Nacional de Tucumán , Tucumán, Argentina

    Juan F. Villalonga

Authors
  1. Amparo Sáenz
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  2. Eugenia Badaloni
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  3. Miguel Grijalba
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  4. Juan F. Villalonga
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  5. Romina Argañaraz
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  6. Beatriz Mantese
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Corresponding author

Correspondence to Amparo Sáenz.

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Ethics approval

Hospital Garrahan´s Ethic Committee approved the manuscript, and we certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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There is no need for informed consent since all information and brain scans are anonymized and the submission does not include images that may identify any person.

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The authors have no conflicts of interest to declare that are relevant to the content of this article.

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Sáenz, A., Badaloni, E., Grijalba, M. et al. Risk factors for surgical site infection in pediatric posterior fossa tumors. Childs Nerv Syst 37, 3049–3056 (2021). https://doi.org/10.1007/s00381-021-05256-y

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  • DOI: https://doi.org/10.1007/s00381-021-05256-y

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