Effectiveness of bundles to prevent surgical site infections in cranial neurosurgery: systematic review, meta-analysis, and GRADE evaluation

INTRODUCTION cranial neurosurgery involves high-risk procedures with major clinical and economic implications. Effective preventive measures against surgical site infections (SSIs) can reduce morbidity, mortality, and healthcare costs. This systematic review and meta-analysis evaluated the effectiveness of care bundles in preventing SSIs in cranial neurosurgery.

METHODS following PRISMA guidelines, a systematic search identified controlled studies (2014-2024) evaluating SSI prevention bundles in cranial neurosurgery. Meta-regression was performed, and evidence certainty was assessed using GRADE.

RESULTS of 3945 records, 14 studies met inclusion criteria. Bundles integrated pre-, intra-, and postoperative measures. Implementation significantly reduced SSI incidence (pooled odds ratio [OR] 0.34; 95% confidence interval [CI] 0.23-0.51; p < 0.01). The presence of antimicrobial prophylaxis within bundles was associated with lower SSI risk (OR 0.45; 95% CI 0.22-0.92; p = 0.031). Evidence certainty was rated low, mainly due to observational design, though risk of bias, imprecision, and inconsistency were minimal.

CONCLUSION standardized care bundles effectively prevent SSIs in cranial neurosurgery, particularly when antimicrobial prophylaxis is included. These findings support adopting multimodal, evidence-based strategies in perioperative infection prevention protocols.

REGISTRATION The study protocol was registered with the Open Science Framework (OSF) Registries prior to the literature search and is available from: https://doi.org/10.17605/OSF.IO/UBZW7.