Postoperative intracranial neurosurgery infection rates in North America versus Europe: A systematic analysis

Background: Postoperative wound infection (PWI) after intracranial neurosurgery remains a significant worldwide problem, resulting in substantial morbidity/mortality if not combatted quickly and energetically. Although the danger of PWI is universally recognized, the reported incidence of PWI after intracranial neurosurgery remains variable, ranging from 1% to 8% in published series. The impact of geography on this reported variability has not been previously investigated. To address this issue, published comprehensive intracranial neurosurgery series were reviewed, segregating findings geographically between North American and European series. Methods: A comprehensive literature search was conducted using the Entrez gateway of the PubMed database. Studies conducted in North America and Europe reporting the incidence of PWI after intracranial neurosurgery were subjected to a thorough review. Data from studies meeting inclusion criteria (minimum of 500 cases with no systematic exclusion of procedures) were categorized by origin (North American/European) and design (retrospective/prospective). Recorded incidences were then compared using X, analysis, and estimates of the relative risk of PWI were calculated. Results: Seven studies (4 North American, 3 European) met all of the inclusion criteria, with a 2.6-fold greater PWI incidence reported in the European studies (P < .001). The relative risk of PWI for Europeans versus North Americans per operative case was 2.60. Conclusion: PWI after intracranial neurosurgery was nearly 3 times more likely in European versus North American studies. These findings should be considered by clinicians when estimating the risks of intracranial neurosurgery, and highlight the need for future prospective studies to provide evidence-based explanations for these differences. (Am J Infect Control 2008,36:570-3.)