{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:27:09Z","timestamp":1793384829888,"version":"4.5.0"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Asian J Neurosurg"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>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.<\/jats:p><jats:p>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.<\/jats:p><jats:p>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\u2009&lt;\u20090.001). Hydrocortisone use was associated with reduced vasopressor requirements and shorter hospital stays (p\u2009=\u20090.001 and p\u2009&lt;\u20090.001, respectively). Thiamine use was linked to a shorter hospital stay (p\u2009=\u20090.023), while continuous renal replacement therapy significantly reduced vasopressor use (p\u2009=\u20090.013).<\/jats:p><jats:p>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.<\/jats:p>","DOI":"10.1055\/s-0045-1809051","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T18:47:59Z","timestamp":1746125279000},"page":"564-571","source":"Crossref","is-referenced-by-count":1,"title":["Management Protocols for Sepsis and Septic Shock after Craniotomy: Clinical Outcomes and Survival Analysis"],"prefix":"10.1055","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3989-1301","authenticated-orcid":false,"given":"Panu","family":"Boontoterm","sequence":"additional","affiliation":[{"name":"Neurological Surgery Unit, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siraruj","family":"Sakoolnamarka","sequence":"additional","affiliation":[{"name":"Neurological Surgery Unit, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karanarak","family":"Urasyanandana","sequence":"additional","affiliation":[{"name":"Neurological Surgery Unit, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pusit","family":"Fuengfoo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,5,1]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.jocn.2020.06.015","article-title":"Sepsis after elective neurosurgery: incidence, outcomes, and predictive factors","volume":"78","author":"N J Pertsch","year":"2020","journal-title":"J Clin Neurosci"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s13054-016-1596-7","article-title":"The impact of post-operative sepsis on mortality after hospital discharge among elective surgical patients: a population-based cohort study","volume":"21","author":"L Ou","year":"2017","journal-title":"Crit Care"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.jocn.2016.02.014","article-title":"United States neurosurgery annual case type and complication trends between 2006 and 2013: an American College of Surgeons National Surgical Quality Improvement Program analysis","volume":"31","author":"D J Cote","year":"2016","journal-title":"J Clin Neurosci"},{"issue":"07","key":"ref4","doi-asserted-by":"crossref","first-page":"1971","DOI":"10.1007\/s00268-017-4415-7","article-title":"Emergency-to-elective surgery ratio: a global indicator of access to surgical care","volume":"42","author":"M Prin","year":"2018","journal-title":"World J Surg"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1089\/sur.2018.186","article-title":"Risk factors for post-operative sepsis and septic shock in patients undergoing emergency surgery","volume":"20","author":"V Gabriel","year":"2019","journal-title":"Surg Infect (Larchmt)"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.eururo.2021.11.014","article-title":"Re: Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021","volume":"81","author":"F ME Wagenlehner","year":"2022","journal-title":"Eur Urol"},{"issue":"11","key":"ref7","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021","volume":"47","author":"L Evans","year":"2021","journal-title":"Intensive Care Med"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1097\/CCM.0b013e3181cb0cdc","article-title":"The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis","volume":"38","author":"M M Levy","year":"2010","journal-title":"Crit Care Med"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.wneu.2016.09.056","article-title":"Neurosurgical infection rates and risk factors: a national surgical quality improvement program analysis of 132,000 patients, 2006-2014","volume":"97","author":"A V Karhade","year":"2017","journal-title":"World Neurosurg"},{"issue":"04","key":"ref10","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1097\/01.CCM.0000259463.33848.3D","article-title":"Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality","volume":"35","author":"H B Nguyen","year":"2007","journal-title":"Crit Care Med"},{"issue":"06","key":"ref11","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.jclinepi.2007.11.007","article-title":"Marginal structural models might overcome confounding when analyzing multiple treatment effects in observational studies","volume":"61","author":"D Suarez","year":"2008","journal-title":"J Clin Epidemiol"},{"issue":"19","key":"ref12","doi-asserted-by":"crossref","first-page":"2322","DOI":"10.1001\/jama.299.19.2322","article-title":"Improving sepsis care: the road ahead","volume":"299","author":"J M Kahn","year":"2008","journal-title":"JAMA"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1016\/j.amjsurg.2009.05.025","article-title":"Sepsis in general surgery: a deadly complication","volume":"198","author":"L J Moore","year":"2009","journal-title":"Am J Surg"},{"issue":"03","key":"ref14","first-page":"672","article-title":"The epidemiology of sepsis in general surgery patients","volume":"70","author":"L J Moore","year":"2011","journal-title":"J Trauma"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/j.amjsurg.2010.07.036","article-title":"Computerized clinical decision support improves mortality in intra abdominal surgical sepsis","volume":"200","author":"L J Moore","year":"2010","journal-title":"Am J Surg"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1007\/s00101-003-0496-9","article-title":"Septische Enzephalopathie. Differential diagnose und therapeutische Einflussm\u00f6glichkeiten","volume":"52","author":"V Eggers","year":"2003","journal-title":"Anaesthesist"},{"issue":"06","key":"ref17","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1097\/01.CCM.0000217961.75225.E9","article-title":"Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock","volume":"34","author":"A Kumar","year":"2006","journal-title":"Crit Care Med"},{"issue":"07","key":"ref18","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1097\/00003246-200107000-00002","article-title":"Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care","volume":"29","author":"D C Angus","year":"2001","journal-title":"Crit Care Med"},{"issue":"05","key":"ref19","doi-asserted-by":"crossref","first-page":"216","DOI":"10.5694\/j.1326-5377.2002.tb04376.x","article-title":"Postoperative serious adverse events in a teaching hospital: a prospective study","volume":"176","author":"R Bellomo","year":"2002","journal-title":"Med J Aust"},{"issue":"06","key":"ref20","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1093\/bja\/aei257","article-title":"Predictive perioperative factors for developing severe sepsis after major surgery","volume":"95","author":"D Mokart","year":"2005","journal-title":"Br J Anaesth"},{"issue":"04","key":"ref21","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1089\/109629603322761418","article-title":"Risk factors for severe sepsis in secondary peritonitis","volume":"4","author":"D A Anaya","year":"2003","journal-title":"Surg Infect (Larchmt)"},{"issue":"04","key":"ref22","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1097\/CCM.0b013e318168f649","article-title":"The costs and cost-effectiveness of an integrated sepsis treatment protocol","volume":"36","author":"D Talmor","year":"2008","journal-title":"Crit Care Med"},{"issue":"05","key":"ref23","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1097\/01.CCM.0000261886.65063.CC","article-title":"Economic implications of an evidence-based sepsis protocol: can we improve outcomes and lower costs?","volume":"35","author":"A F Shorr","year":"2007","journal-title":"Crit Care Med"},{"issue":"24","key":"ref24","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1056\/NEJM199406163302404","article-title":"Elevation of systemic oxygen delivery in the treatment of critically ill patients","volume":"330","author":"M A Hayes","year":"1994","journal-title":"N Engl J Med"},{"issue":"16","key":"ref25","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1056\/NEJM199510193331601","article-title":"A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 Collaborative Group","volume":"333","author":"L Gattinoni","year":"1995","journal-title":"N Engl J Med"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"S513","DOI":"10.1097\/01.CCM.0000143119.41916.5D","article-title":"Source control in the management of severe sepsis and septic shock: an evidence-based review","volume":"32","author":"J C Marshall","year":"2004","journal-title":"Crit Care Med"},{"issue":"12","key":"ref27","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.5005\/jp-journals-10071-24363","article-title":"Bacterial meningitis among intracranial surgery patients at a university hospital in Northern India","volume":"26","author":"M Kar","year":"2022","journal-title":"Indian J Crit Care Med"},{"issue":"12","key":"ref28","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.5005\/jp-journals-10071-24368","article-title":"The menace of meningitis!","volume":"26","author":"H Prabhakar","year":"2022","journal-title":"Indian J Crit Care Med"},{"issue":"08","key":"ref29","doi-asserted-by":"crossref","first-page":"760","DOI":"10.5005\/jp-journals-10071-24768","article-title":"Development of an evidence-based care bundle for prevention of external ventricular drain-related infection: results of a single-center prospective cohort study and literature review","volume":"28","author":"D K Ponnambath","year":"2024","journal-title":"Indian J Crit Care Med"}],"container-title":["Asian Journal of Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0045-1809051.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T22:42:12Z","timestamp":1755816132000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0045-1809051"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,1]]},"references-count":29,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2025,8,21]]},"published-print":{"date-parts":[[2025,9]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0045-1809051","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1793-5482","2248-9614"],"issn-type":[{"value":"1793-5482","type":"print"},{"value":"2248-9614","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,1]]}}}