Effect of preoperative hospital stay on surgical site infection in Chinese cranial neurosurgery

OBJECTIVE: Surgical site infection(SSI)after neurosurgical procedure can be devastating. Delayed hospital stay has been identified as a potentially modifiable driver of SSI in general surgery patients. However, the relationship between preoperative length of stay and SSI has not been quantified previously in neurosurgery. This study aimed to clarify the association. DESIGN: A Cohort study based on STROBE checklist. METHOD: This observational study focused on cranial neurosurgery patients at a tertiary referral centers in China. Data collection from hospital information system conducted between 1 January 2016 and 31 December 2016 was used to examine the results of interest (n = 600). Logistic regression analysis explored association between preoperative length of stay and SSI, adjusting for potential confounders. RESULTS: Overall SSI prevalence was 10.8% and was significantly higher in the longer preoperative length of stay group. Besides preoperative length of stay, American Society of Anesthesiologists score, type of surgery, gross blood loss also significantly associated with SSI prevalence. Compared with 1 to 2 days, longer preoperative length of stay was associated with increased SSI prevalence after adjustment for confounders (3 to 4 days: odds ratio[OR], 0.975[95%CI, 0.417 to 2.281]; 5 to 6 days: OR, 2.830[95%CI, 1.092 to 7.332]; 7 or more days: OR, 4.039[95%CI, 1.164 to 14.015]; P for trend < 0.001). On the other hand, we found a positive association between preoperative length of stay to deep/space-organ SSI (OR = 1.404; 95% CI: 1.148 to 1.717; P for trend < 0.001), which was higher than superficial SSI (OR = 1.242; 95% CI: 0.835 to1.848; P for trend= 0.062). CONCLUSIONS: In a cohort of patients from a single center retrospective surgical registry, a longer preoperative length of stay was associated with a higher incidence of cranial neurosurgical SSI. There is room for improvement in preoperative length of stay. This can be used for hospital management and to stratify patients with regard to SSI risk.