Deep Brain Stimulation-Related Surgical Site Infections: A Systematic Review and Meta-Analysis.
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.
['Kantzanou|Maria|M|', 'Korfias|Stefanos|S|', 'Panourias|Ioannis|I|', 'Sakas|Damianos E|DE|', 'Karalexi|Maria A|MA|https://orcid.org/0000-0003-3022-4382']
D046690:Deep Brain Stimulation D020821:Dystonic Disorders D004567:Electrodes, Implanted D004827:Epilepsy D006801:Humans D013530:Surgical Wound Infection D014640:Vancomycin
surgical site infection meta-analysis Deep brain stimulation prevalence prevention