Neurosurgeons Identify Key Risk Factors for Postoperative Infections

A recent study published in Acta Neurochirurgica analyzed a pragmatic cohort of non-ICU neurosurgical patients to determine the incidence, types, and outcomes of these infections. The research team, led by Andreas Theofanopoulos and colleagues, sought to validate infection risk factors specifically within the ward-level neurosurgical population, noting that findings from intensive care units may not apply to patients managed on general wards.

The study prospectively collected data on demographics, medical history, operative details, perioperative interventions, and hospitalization metrics. Patients requiring intensive care unit hospitalization were explicitly excluded from the analysis to ensure the results reflected the specific risks faced by ward-level patients. This methodological choice allows for a more precise understanding of how standard neurosurgical care impacts infection rates outside of the highly monitored environment of the ICU.

The results revealed that 137 postoperative infection events were recorded in 126 patients. Pneumonia was the most common type of infection, accounting for 70.1% of all cases, followed by urinary tract infections at 10.2% and surgical site infections at 9.5%. Other less frequent complications included bacteremia of undetermined source at 5.1%, central-line-associated bloodstream infection at 3.6%, and meningitis at 1.5%. These statistics highlight the diverse nature of postoperative infections in neurosurgery, with respiratory and urinary tract issues dominating the clinical picture.

The impact of these infections on patient outcomes was also significant. The hospitalization period was extended due to postoperative infection in 10.5% of operations, indicating a substantial burden on healthcare resources and patient recovery time. Furthermore, 0.8% of the patients in the cohort died, underscoring the potential severity of these complications.

Through multivariable analysis, the researchers identified several independent factors associated with postoperative infection. Age emerged as a significant predictor, with an adjusted odds ratio of 1.017, indicating that older patients face a higher risk. Immobilization for more than 24 hours was also a strong risk factor, with an adjusted odds ratio of 2.91. These findings suggest that patient mobility and age are critical considerations in postoperative care planning.

The duration of medical device usage also played a crucial role in infection risk. Patients with an indwelling Foley catheter for more than 48 hours had an adjusted odds ratio of 4.0 for infection, while those with a central venous catheter for the same duration faced an adjusted odds ratio of 3.99. Additionally, the insertion of foreign material was associated with a significantly higher risk, with an adjusted odds ratio of 5.15. These results highlight catheter retention beyond 48 hours and foreign-material insertion as modifiable-appearing factors associated with infection risk in this ward-level cohort.

The type of surgery performed was another key determinant of infection risk. Spinal surgery was associated with a higher likelihood of postoperative infection compared to cranial surgery, with an adjusted odds ratio of 4.90. The study also noted that prolonged operative time was specifically associated with postoperative pneumonia, suggesting that the length of the procedure may impact respiratory outcomes.

The authors concluded that aggressive preoperative and postoperative measures, utilizing ERAS-like protocols, may help reduce the infection burden and optimize outcomes. By addressing modifiable risk factors such as catheter duration and patient immobilization, healthcare providers can potentially lower the incidence of these complications. The study reinforces the need for tailored infection prevention strategies that account for the specific risks associated with different types of neurosurgical procedures.

It is important to note that these findings validate infection risk factors specifically within the ward-level neurosurgical population and should not be extrapolated to patients requiring ICU management.

Subject of Research: Risk factors for postoperative infections in non-ICU neurosurgical patients

Article Title: Predictors of postoperative infections in a tertiary neurosurgical center

Article References: Theofanopoulos, A., Assimakopoulos, S. F., Faropoulos, K., & Constantoyannis, C. (2026). Predictors of postoperative infections in a tertiary neurosurgical center. Acta Neurochirurgica. https://doi.org/10.1007/s00701-026-07060-6

Image Credits: AI Generated

DOI: 10.1007/s00701-026-07060-6

Keywords: neurosurgery, postoperative infection, clinical risk factors, pneumonia, surgical site infection, hospital outcomes, patient safety, tertiary care, Predictors, postoperative, infections, tertiary