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Our Neurosurgeons Catch Medication That Boosts Risk for Infection

illustration surgical instruments

Imagine hearing, “Your brain surgery was a success. Go home. Rest.”

And you do.

You settle back into your home and recover. The incision on your head heals beautifully, and the scar fades as you continue with your life.

Unfortunately, some patients aren’t so lucky. Very rarely, recoveries are interrupted when an incision becomes infected, which isn’t limited to brain surgery, or surgery in general. Even a finger cut while dicing carrots can puff up and turn red.

Because our neurosurgeons want the best outcomes for all their patients, even the rare chance of an incision becoming infected is unacceptable, and they are looking to eliminate it.

Although rare, an infected surgical incision is actually the most common type of infection you can get in a hospital, often meaning extra time in the hospital and more bills. Across the nation, that extra time adds up to 1 million extra days in the hospital and more than $1.5 billion in healthcare costs.

But good news: Drs. Jeffrey N. Bruce, E. Sander Connolly Jr. and Adam M. Sonabend from the Columbia University Medical Center/NewYork-Presbyterian Hospital Department of Neurosurgery, along with their coauthors* Dr. Geoffrey Appelboom, Dr. Christopher Kellner, Blake E. Taylor and Eliza M. Bruce, merged their expertise to conduct a study to address this problem.

They studied two medications often given to patients before brain surgery: chemotherapy and corticosteroids. Chemotherapy is given to manage brain cancer, and corticosteroids to reduce inflammation and, in turn, minimize swelling within the brain—a life-threatening condition.

However, despite their benefits, these medications can weaken the body’s ability to fight infection. A study had yet to show whether those medications predispose the incision on your head to becoming infected after brain surgery.

That’s where our neurosurgeons, with their coauthors, stepped in to lead one of the first and largest studies of its kind. These experts looked at whether giving patients chemotherapy and corticosteroids before brain surgery increased the risk of getting an infected surgical incision within 30 days after surgery.

To do so, the authors collected and analyzed data from the records of 8,215 patients who had undergone brain surgery. They found patients who received either chemotherapy or corticosteroids before surgery were more likely to get an infected surgical incision within 30 days after surgery—but only if the incision went deep enough to reach the brain. If the incision broke only the skin or muscle layers, risk was not increased.

This finding is not grounds to discontinue using chemotherapy or corticosteroids, instead it’s a call to optimize their dosing and timing. They published their results in the Journal of Neurosurgery. Read the article online here.

But the work doesn’t stop there.

The neurosurgeons encourage future studies to determine which type of, how much and how long chemotherapy or corticosteroids should be given. Knowing more will allow patients to experience the benefits of these medications before brain surgery as well as recover comfortably in their own homes as their incisions heal, infection-free.

Read more about Dr. E. Sander Connolly Jr. here.

Read more about Dr. Jeffrey N. Bruce here.

*Full list of authors:
Bryan A. Lieber, Geoffrey Appelboom, Blake E. Taylor, Franklin D. Lowy, Eliza M. Bruce, Adam M. Sonabend, Christopher Kellner, E. Sander Connolly Jr. and Jeffrey N. Bruce

Image Credit: © [eatcute]/Adobe Stock

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