Predictors of postoperative infections in a tertiary neurosurgical center

Postoperative infections are common neurosurgical complications with considerable morbidity. We assessed the incidence, type and outcomes of postoperative infections in a pragmatic cohort of non-ICU neurosurgical patients. Demographics, medical history, operative details, perioperative interventions and hospitalization metrics were prospectively collected. Patients requiring intensive care unit hospitalization were excluded. 137 postoperative infection events were recorded in 126 patients. Of 137 infections, pneumonia accounted for 70.1%, urinary tract infection for 10.2%, central-line-associated bloodstream infection (CLABSI) for 3.6%, bacteremia of undetermined source for 5.1%, surgical site infection (SSI) for 9.5% and meningitis for 1.5%. The hospitalization was extended due to postoperative infection in 10.5% of operations, while 0.8% of the patients died. Independent factors associated with postoperative infection after multivariable analysis were age (adjusted OR 1.017, 95% CI 1.002–1.033), immobilization > 24 h (aOR 2.91, 95% CI 1.62–5.24), indwelling foley catheter > 48 h (aOR 4, 95% CI 2.01–7.99), central venous catheter (CVC) > 48 h (aOR 3.99, 95% CI 1.64–9.74), foreign material insertion (aOR 5.15, 95% CI 2.61–10.15) and spinal compared to cranial surgery (aOR 4.90, 95% CI 2.63–9.15). Independent factors associated with postoperative infection included older age, immobilization beyond 24 h, retention of urinary and central venous catheters beyond 48 h and foreign-material insertion; prolonged operative time was associated specifically with postoperative pneumonia. Aggressive preoperative and postoperative measures utilizing ERAS-like protocols may reduce infection burden and optimize outcomes. These findings validate infection risk factors specifically within the ward-level neurosurgical population and should not be extrapolated to patients requiring ICU management.