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An update on a persisting challenge: a systematic review and meta-analysis of the risk factors for surgical site infection post craniotomy.

BACKGROUND: Surgical site infections (SSIs) post-craniotomy continue to impose a significant burden on healthcare systems and patient outcomes. It is therefore important to understand their risk factors in order to promote effective preventative measures. This meta-analysis aims to provide a comprehensive, up to date analysis of the risk factors associated with SSIs in neurosurgical procedures.

METHODS: A systematic review was conducted as per PRISMA guidelines to explore existing primary evidence on the risk factors for SSIs post- craniotomy. A comprehensive search of MEDLINE, EMBASE and Pubmed was performed from database inception up to June 2023. 43 studies were included in the meta-analysis, encompassing a total of 68,881 patients.

RESULTS: The strongest predictor for SSIs was found to be CSF leak (OR: 8.91, CI: 4.30 - 18.44). Other significant factors included infratentorial surgery (OR: 0.43, CI: 0.31 - 0.61), emergency surgery (OR: 1.41, CI: 1.05 - 1.91), re-intervention (OR: 3.19, CI: 1.77 - 5.75), prolonged operative time (mean difference: 33.25; CI: 18.83 - 47.67), hospital length of stay (mean difference: 0.60; CI: 0.23 - 0.98) and ICPM insertion (OR: 1.81; CI: 1.06 - 3.11). Contrarily, sex, BMI, diabetes, antibiotic prophylaxis, immunosuppressive agents, trauma, use of artificial implants did not demonstrate statistical significance.

CONCLUSIONS: This meta-analysis provides an up-to-date and comprehensive evaluation of risk factors for SSIs post-craniotomy. It emphasizes the need for preventive strategies, particularly against CSF leaks, and calls for further research to elucidate the intricate relationships between these factors.

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