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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1809051
Original Article

Management Protocols for Sepsis and Septic Shock after Craniotomy: Clinical Outcomes and Survival Analysis

Panu Boontoterm 
1   Neurological Surgery Unit, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
,
Siraruj Sakoolnamarka
1   Neurological Surgery Unit, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
,
Karanarak Urasyanandana
1   Neurological Surgery Unit, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
,
Pusit Fuengfoo
2   Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
› Author Affiliations Funding None.
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Abstract

Objectives

Central nervous system infections are linked to a substantial rise in perioperative mortality, with postoperative neurosurgical infections being both prevalent and severe. Although the Surviving Sepsis Campaign (SSC) guidelines offer a framework for managing sepsis, their effect on clinical outcomes in neurosurgical patients has yet to be fully explored. The aim of this study was to compare mortality rates and clinical outcomes in neurosurgical patients with sepsis and septic shock treated according to the SSC protocol versus standard care.

Materials and Methods

This single-center retrospective analysis on prospectively acquired data included 159 patients with neurosurgical sepsis and septic shock, divided into two groups: 77 patients managed according to the SSC guidelines and 82 patients receiving standard treatment. Data on baseline characteristics, initial management within the first hour, and 30-day clinical outcomes were collected and analyzed.

Results

The mortality rate was significantly lower in the SSC protocol group. Additionally, intensive care unit (ICU) length of stay was significantly shorter, and the number of ventilator- and vasopressor-free days was significantly higher in the SSC protocol group (p < 0.001). Hydrocortisone use was associated with reduced vasopressor requirements and shorter hospital stays (p = 0.001 and p < 0.001, respectively). Thiamine use was linked to a shorter hospital stay (p = 0.023), while continuous renal replacement therapy significantly reduced vasopressor use (p = 0.013).

Conclusion

Implementing the SSC protocol within the first hour of treatment significantly reduced mortality, shortened ICU length of stay, and increased the number of ventilator- and vasopressor-free days.

Keywords

central nervous system infections - mortality rate - Surviving Sepsis Campaign - sepsis - protocol - perioperative mortality

Note

This original article has not been previously published, nor has it been presented to another journal for consideration.


Authors' Contributions

P.B.: Project administration and coordination, wrote the original draft of the manuscript, participated in the review process, and data curation. P.B., S.S., and P.F.: Data curation, wrote the original draft of the manuscript, participated in the review process, and data curation. P.B. and K.U.: Data curation and formal analysis of the research. P.B.: Participated in the review process. P.F. and K.U.: Project administration, coordination, and participated in the review process. All the authors have read and approved the final manuscript.


Ethical Approval

The study received approval from the Thai Clinical Trials Registry Committee (TCTR20240316003, March 16, 2024) and the Ethics Committee of the Institutional Review Board, Medical Department (IRBRTA 1861/2564). It was conducted in accordance with the Declaration of Helsinki and the Foundation for Human Research Promotion in Thailand. Due to the use of anonymized medical records and aggregate data, written consent was not required, as per the CIOMS Guidelines 2012 and Good Clinical Practice of the International Conference on Harmonization.




Publication History

Article published online:
01 May 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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