Preoperative chemotherapy and corticosteroids: independent predictors of XXXX .

@entity1 @entity28 @entity281 @entity86 @entity1431 @entity130 @entity479
UNASSIGNED: OBJECT Preoperative corticosteroids and chemotherapy are frequently prescribed for @entity1 undergoing cranial neurosurgery but may pose a risk of @entity86 . @entity86 (SSIs) have significant morbidity and mortality, dramatically increase the length and cost of hospitalization, and are a major cause of 30-day readmission. In @entity1 undergoing cranial neurosurgery, there is a lack of data on the role of @entity1 -specific risk factors in the development of SSIs. The authors of this study sought to determine whether chemotherapy and prolonged @entity479 use before surgery increase the risk of an SSI at postoperative Day 30. METHODS Using the national prospectively collected American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database for 2006-2012, the authors calculated the rates of superficial, deep-incisional, and organ-space SSIs at postoperative Day 30 for neurosurgery @entity1 who had undergone chemotherapy or had significant @entity479 use within 30 days before undergoing cranial surgery. @entity130 @entity1 , @entity1 younger than 18 years, and @entity1 with a preoperative @entity281 were excluded. Univariate analysis was performed for 25 variables considered risk factors for superficial and organ-space SSIs. To identify independent predictors of SSIs, the authors then conducted a multivariate analysis in which they controlled for duration of operation, wound class, white blood cell count, and other potential confounders that were significant on the univariate analysis. RESULTS A total of 8215 @entity1 who had undergone cranial surgery were identified. There were 158 SSIs at 30 days (frequency 1.92%), of which 52 were superficial, 27 were deep-incisional, and 79 were organ-space @entity281 . Preoperative chemotherapy was an independent predictor of organ-space SSIs in the multivariate model (OR 5.20, 95% CI 2.33-11.62, p < 0.0001), as was corticosteroid use (OR 1.86, 95% CI 1.03-3.37, p = 0.04), but neither was a predictor of superficial or deep-incisional SSIs. Other independent predictors of organ-space SSIs were longer duration of operation (OR 1.16), wound class of >=  2 (clean-contaminated and further contaminated) (OR 3.17), and morbid @entity28 (body mass index >=  40 kg/m(2)) (OR 3.05). Among superficial SSIs, wound class of 3 (contaminated) (OR 6.89), operative duration (OR 1.13), and infratentorial surgical approach (OR 2.20) were predictors. CONCLUSIONS Preoperative chemotherapy and corticosteroid use are independent predictors of organ-space SSIs, even when data are controlled for @entity1431 . This indicates that the disease process in organ-space SSIs may differ from that in superficial SSIs. In effect, this study provides one of the largest analyses of risk factors for SSIs after cranial surgery. The results suggest that, in certain circumstances, modulation of preoperative chemotherapy or @entity479 regimens may reduce the risk of organ-space SSIs and should be considered in the preoperative care of this population. Future studies are needed to determine optimal timing and dosing of these medications.
