title: An Analysis of Scalp Thickness and Other Novel Risk Factors for Deep Brain Stimulator Infections.
abstract: BACKGROUND
  Deep brain stimulator (DBS) infections are a persistent problem for patients undergoing this procedure. They may require further surgery, treatment with antibiotics, or even removal of the device. To date, no consensus exists on the best practices to avoid DBS infections or what factors predispose patients to an eventual infection. The goal of this study was to examine several patient factors for association with DBS infection.
  
  
  METHODS
  A single-center, single-surgeon quality improvement database was queried. All patients who experienced an infection were identified. The primary variable analyzed was scalp thickness. Other pre-specified, secondary variables included routine intraoperative cultures, operative time, diagnosis, and age.
  
  
  RESULTS
  None of the independent variables examined were significantly associated with DBS infections. Only two of the 46 infections qualified as surgical site infections as defined by the Centers for Disease Control.
  
  
  CONCLUSIONS
  DBS infections are independent of all of the predictor variables analyzed. Surgical site infections, according to traditional definitions, are not the optimal definition for evaluating DBS infections/erosions. New studies must examine new variables that are not routinely gathered in this population. Also, because of the rare event rates and difficulty in randomizing patients to exposures, a large, multicenter registry may be the optimal study design to solve this clinical problem.
authors: Department of Neurosurgery, Penn State Milton S Hershey Medical Center.
authors: Nicholas
authors: N
authors: Brandmeir
authors: Department of Neurosurgery, Penn State Milton S Hershey Medical Center.
authors: Elena
authors: E
authors: Nehrbass
authors: Department of Neurosurgery, Penn State Milton S Hershey Medical Center.
authors: James
authors: J
authors: McInerney
keywords: dbs; dbs infection; deep brain stimulator infection; infection; scalp thickness