Surgical-site infection surveillance in cranial neurosurgery

Abstract

Introduction. Surgical-site infection (SSI) is associated with significant morbidity and mortality. Public Health England or PHE has published guidance on its surveillance, which is now mandatory in some specialities. We review how appropriate their programme is for monitoring SSI in cranial neurosurgery [CN]. Method. SSI data on all patients [N = 2375] undergoing CN, over two years, at Salford Royal Foundation NHS Trust or SRFT were prospectively recorded. SSI was defined as arising within 30 days of operation or 1 year where an implant(s) remains. Follow-up, by a dedicated SSI nurse, was at 30 days using inpatient, outpatient clinic or telephone consultation, or post-discharge postal questionnaires [PDpQ] and by monitoring for readmissions. A descriptive analysis was performed looking at the follow-up process and SSI rate. Results. Thirty-day follow-up data was obtained in 1776 patients (74.8%). Overall, 82 (3.5%) patients had a confirmed SSI. 22/82 (27%) were identified as inpatients [median time from operation: 14.5 days, inter-quartile range (IQR): 16] and 60/82 (73%) as readmissions [median time from operation: 31.5 days, IQR: 186.5]. No SSIs were identified via PDpQ. Conclusions. These data suggest that active outpatient follow-up is not necessary and that monitoring of inpatients and readmissions is enough for a cranial neurosurgical SSI programme.