Περίληψη:
Background: Over the last decades, the increased use of deep brain stimulation (DBS) has raised concerns about the potential adverse health effects of the treatment. Surgical site infections (SSIs) following an elective surgery remain a major challenge for neurosurgeons. Few studies have examined the prevalence and risk factors of DBS-related complications, particularly focusing on SSIs. Objectives: We systematically searched published literature, up to June 2020, with no language restrictions. Materials and Methods: Eligible were studies that examined the prevalence of DBS-related SSIs, as well as studies that examined risk and preventive factors in relation to SSIs. We extracted information on study characteristics, follow-up, exposure and outcome assessment, effect estimate and sample size. Summary odds ratios (sOR) and 95% confidence intervals (CI) were calculated from random-effects meta-analyses; heterogeneity and small-study effects were also assessed. Results: We identified 66 eligible studies that included 12,258 participants from 27 countries. The summary prevalence of SSIs was estimated at 5.0% (95% CI: 4.0%–6.0%) with higher rates for dystonia (6.5%), as well as for newer indications of DBS, such as epilepsy (9.5%), Tourette syndrome (5.9%) and OCD (4.5%). Similar prevalence rates were found between early-onset and late-onset hardware infections. Among risk and preventive factors, the perioperative implementation of intra-wound vancomycin was associated with statistically significantly lower risk of SSIs (sOR: 0.26, 95% CI: 0.09–0.74). Heterogeneity was nonsignificant in most meta-analyses. Conclusion: The present study confirms the still high prevalence of SSIs, especially for newer indications of DBS and provides evidence that preventive measures, such as the implementation of topical vancomycin, seem promising in reducing the risk of DBS-related SSIs. Large clinical trials are needed to confirm the efficacy and safety of such measures. © 2021 International Neuromodulation Society
Συγγραφείς:
Kantzanou, M.
Korfias, S.
Panourias, I.
Sakas, D.E.
Karalexi, M.A.
Λέξεις-κλειδιά:
vancomycin; vancomycin, brain depth stimulation; brain ventricle peritoneum shunt; cluster headache; device infection; device safety; disease association; drug efficacy; drug safety; dystonia; elective surgery; epilepsy; essential tremor; Gilles de la Tourette syndrome; high risk patient; human; incidence; infection prevention; infection risk; meta analysis; multiple sclerosis; nonhuman; obsessive compulsive disorder; Parkinson disease; perioperative period; prevalence; Review; risk reduction; surgical infection; systematic review; tardive dyskinesia; dystonic disorder; epilepsy; surgical infection, Deep Brain Stimulation; Dystonic Disorders; Epilepsy; Humans; Surgical Wound Infection; Vancomycin
