• Naoto Kuroda, Ayataka Fujimoto, Tohru Okanishi, Keishiro Sato, Shinji Itamura, Shimpei Baba, Mitsuyo Nishimura, Naoki Ichikawa, and Hideo Enoki.
• Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
• World Neurosurg. 2019 Oct 1; 130: e839-e845.

BackgroundRisk factors for infection after vagus nerve stimulation (VNS) device implantation represent an important issue but remain unclear. We hypothesized that specific risk factors for infection would be associated with VNS device implantation. This study reviewed patients with epilepsy who underwent VNS device implantation and undertook a statistical analysis of risk factors for surgical site infection (SSI).MethodsWe reviewed all medical records for patients who underwent VNS therapy in our facility between August 2011 and May 2018. Age, sex, height, body weight, body mass index (BMI), intelligence quotient (IQ), surgical incision opening time, blood loss, epilepsy classification, activities of daily living, and generator replacement were statistically compared between cases with and without SSI.ResultsWe performed 208 VNS device implantation surgeries at our facility during the study period. Among these, 150 patients underwent initial implantation, 56 patients underwent first generator replacement, and 2 patients underwent second replacement. Six patients (2.7%) with initial implantation and 3 patients (5.4%) with first replacement showed SSI. Low BMI was a risk factor for infection at initial implantation (P < 0.0012) using a BMI within 1.78 kg/m2 of the cutoff for being underweight (100% sensitivity, 25% specificity). Low IQ (P = 0.0015) was also a risk factor for SSI.ConclusionsThis study identified low BMI and low IQ at initial implantation as risk factors for infection.Copyright © 2019 Elsevier Inc. All rights reserved.

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