title: Surgical site infections after pediatric intracranial surgery for craniofacial malformations: frequency and risk factors.
abstract: OBJECTIVE
  Surgical site infections (SSIs) after pediatric intracranial surgery for craniofacial malformations are relatively common and potentially serious nosocomial infections. Despite this, few studies have been published on this topic. We performed a retrospective study to determine the incidence of and factors associated with SSIs after intracranial surgery for craniofacial malformations at a single multidisciplinary craniofacial center during a 6-year period.
  
  
  METHODS
  Retrospective chart review was performed on 254 patients who underwent 281 intracranial procedures during a 6-year period. Patients with SSIs (cases) were compared with those without SSIs (controls). National Nosocomial Infection Surveillance System criteria were used to identify cases of SSI.
  
  
  RESULTS
  SSIs occurred in 9 (3.2%) of 281 intracranial procedures that took place during the study period. Factors associated with an SSI included a complicated diagnosis comprising a diagnosis of syndromic craniosynostosis, frontonasal dysplasia, or oblique facial cleft (odds ratio [OR], 13.0; 95% confidence interval [CI], 2.6-64.4); duration of surgery longer than 426 minutes (OR, 12.1; 95% CI, 2.4-59.9); closure of skin under tension (OR, 12.5; 95% CI, 3.0-52.6); use of bovine pericardium (OR and 95% CI undefined); more than four surgeons present during surgery (OR, 6.3; 95% CI, 1.2-32); pediatric intensive care unit stay longer than 2 days (OR, 10.8; 95% CI, 2.2-53.3); and use of a ventilator after surgery (OR, 4.8; 95% CI, 1.2-18.6).
  
  
  CONCLUSIONS
  In this study, the presence of a complicated diagnosis and a number of other factors were associated with an SSI after pediatric intracranial surgery for craniofacial malformations. We speculate that a complicated diagnosis may be a marker for other factors that contribute to the risk of an SSI. Future studies investigating SSIs after intracranial surgery should consider these factors.
authors.affiliation: School of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Laurence C
authors.initials: LC
authors.lastname: Yeung
authors.forename: Michael L
authors.initials: ML
authors.lastname: Cunningham
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Allpress
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Gruss
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ellenbogen
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Zerr
mesh_terms: D002648:Child; D002675:Child, Preschool; D019465:Craniofacial Abnormalities / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*; D016896:Treatment Outcome