Preliminary Attempt To Reduce The Incidence Of Intracranial Infection After Craniotomy In Department Of Neurosurgery

Background and purpose:Intracranial infection(ICI) is a common complication after craniotomy in Department of Neurosurgery, which can lead to the increase in the number of days of hospitalization and the cost of hospitalization. When an abscess is formed, it even needs a reoperation. Moreover, many antimicrobial agents can not play the role of antimicrobial activity through the blood brain barrier. The clinical treatment of intracranial infection is difficult, and once it occurs, the outcome of surgery and prognosis of patients will be seriously affected. Therefore, to understand the relevant risk factors of intracranial infection after craniotomy, and to avoid or correct them in peri operation period, and even further to put forward new ideas to reduce intracranial infection rate, is a topic each neurosurgeon must continue to study and explore in clinical work. This research provides an objective basis for reducing the incidence of ICI after craniotomy through the analysis of the incidence of ICI and related risk factors in patients in the Department of Neurosurgery, the First Hospital of Jilin University. And at the same time, we preliminarily studied a new measure to reduce the incidence of ICI after craniotomy. Methods:Retrospective analysis of 112 patients who underwent supratentorial or Posterior fossa operation from March 2014 to May 2014 and from July 2015 to September 2015 in our department. We collected the following items of the patients: gender, age, pathological types, surgical site, operation time, whether indwelling external ventricular drainage tube,whether combined CSF leakage, whether combined diabetes, etc. We analyzed the influence of those factors on the rate of postoperative ICI. All the cases from July 2015 to September 2015, we placed gelatin sponge with iodophors in the epidural, expecting to lower the ICI. The positive state distribution of the measurement data of continuous data using mean standard deviation of mean plus or minus standard deviation indicates the concentration trend and discrete trend of the data. The non normal distribution of the data with the median plus or minus four quantile interval to show its concentration trend and discrete trend. The distribution of enumeration data is indicated by the percentile. The influence of different factors on postoperative infection was tested by chi square test. The main influencing factors were non conditional Logistic regression analysis, and the independent influencing factors were verified. Results:Too young is a risk factor of ICI postoperative(P=0.032),the infection rate of people under the age of 14 was much higher than that of other age groups; CSF leakage postoperative is a risk factor of ICI(P=0.013); posterior fossa operation is a risk factor of ICI(P=0.009); indwelling external ventricular drainage tube is a risk factor of ICI(P=0.004);the length of the time an operation takes can affect the rate of postoperative ICI(P=0.048), the longer the operation lasts, the higher of the risk of postoperative ICI is. The placement of iodophors gelatin sponge outside the endocranium can reduce the postoperative ICI. There is no significant difference in the incidence of postoperative infection in patients with sex difference(P=0.882); postoperative ICI was not affected by diabetes mellitus( P=0.635); there is no significant difference in the incidence of postoperative infection between benign and malignant tumors(P=0.450).Non conditional Logistic regression analysis showed that posterior fossa operation and CSF leakage postoperative are independent risk factors for the occurrence of postoperative ICI. Conclusion:1.The longer the operation lasts, the higher of the risk of ICI postoperative is.2.These are the risk factors of ICI postoperative: posterior fossa operation,CSF leakage postoperative,indwelling external ventricular drainage tube.3.The influence gender,pathological diagnosis(benign or malignant) have on ICI postoperative have no statistical significance.4. In patients with diabetes mellitus, the control of blood glucose in the normal range during the peri operative period may not necessarily increase the rate of postoperative intracranial infection.5. The placement of iodophors gelatin sponge outside the endocranium can reduce the postoperative intracranial infection incidence of posterior fossa operations and does not cause postoperative epilepsy and epidural hematoma occurred rate increases.