title: Intraoperative angiography does not lead to increased rates of surgical site infections.
abstract: BACKGROUND
  Intraoperative angiography (IOA) is essential in evaluating residual aneurysm following clip ligation, but it does lead to an additional procedure which increases the duration of the procedure as well as increasing room traffic. We examined whether IOA during microsurgery is a risk factor for developing cranial surgical site infection.
  
  
  METHODS
  A retrospective cohort study was performed of all patients undergoing craniotomy for aneurysm treatment between 2005 and 2012 at the University of Michigan. IOA was used at the surgeons' discretion. The primary outcome of interest was occurrence of a surgical site infection and the secondary outcome of interest was clip repositioning following IOA. Variables including IOA were tested for their independent association with the occurrence of a surgical site infection.
  
  
  RESULTS
  During the study period 676 intracranial aneurysms were treated by craniotomy; IOA was used in 104 of these cases. There were a total of 20 surgical site infections, 2 in the IOA group (1.9%) and 18 in the non-IOA group (3.1%), indicating that IOA was not a statistically significant variable for infection (p=0.50). No additional single variable measured could be shown to have a statistically significant increase in infection, and there were no direct complications related to the use of IOA (stroke, dissection, perforation).
  
  
  CONCLUSIONS
  IOA does not increase the risk of developing a surgical site infection. It can be conducted without exposing patients to an undue risk of infection.
authors.affiliation: Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Stetler
authors.affiliation: Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wilson
authors.affiliation: Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Wajd N
authors.initials: WN
authors.lastname: Al-Holou
authors.affiliation: Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Khan
authors.affiliation: Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: B Gregory
authors.initials: BG
authors.lastname: Thompson
authors.affiliation: Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Aditya S
authors.initials: AS
authors.lastname: Pandey
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000706:statistics & numerical data*; D003399:Craniotomy / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000601:surgery*; D007430:Intraoperative Care / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008866:Microsurgery / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*
keywords: Aneurysm; Angiography; Infection