Surgical site infection (SSI) after craniotomy is a serious complication, and the optimal surgical strategy during revision remains controversial. This multicenter, propensity-matched cohort study compared outcomes between bone flap explantation and reimplantationin revision surgery and identified predictors of reinfection. A total of 160 patients undergoing revision surgery for SSI after elective craniotomy were included; 80 underwent bone flap reimplantation and 80 explantation. Patients were matched for age and FRAIL score. Clinical, radiological, microbiological, and surgical variables were analyzed, and predictors of recurrent SSI were assessed using Cox regression analysis. Recurrent SSI occurred significantly less often after bone flap explantation than reimplantation (18% vs. 49%, p = 0.001). Despite signs of more extensive infection in the explantation group, postoperative hospitalization was shorter (7 vs. 12 days, p = 0.051). Factors associated with reduced recurrence included infection limited to subcutaneous tissue, perioperative antibiotic administration, and shorter post-revision hospital stay. This study offers multicenter evidence that bone flap explantation is associated with substantially lower reinfection rates compared with immediate reimplantation which ultimately can improve outcomes and reduce healthcare burden.
Lucia et al. (Mon,) studied this question.