Surgical site infections (SSI) in neurosurgery are frequent and potentially preventable complications, with significant impact on morbidity, mortality, and hospital costs. This study aimed to evaluate the effectiveness of bundle implementation in preventing SSI in cranial neurosurgery. A systematic review with meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, including meta-analysis and meta-regression. The systematic search included controlled studies published between 2014 and 2024 that evaluated the application of SSI prevention bundles in patients undergoing cranial neurosurgery. The initial search identified 3,945 studies, of which 14 were included after application of selection criteria. The analyzed bundles encompassed pre-, intra-, and postoperative measures. Meta-analysis showed that adoption of SSI prevention bundles in cranial neurosurgery significantly reduced SSI rates, with OR 0.34 (95% CI 0.23–0.51; p < 0.01). In meta-regression results, presence of antimicrobial prophylaxis in the bundle was associated with OR 0.45 (95% CI 0.22–0.92; p = 0.031), while its absence increased SSI risk by 124.43%. This systematic review and meta-analysis demonstrate that bundle implementation is an effective strategy to reduce SSI in cranial neurosurgery. Inclusion of antimicrobial prophylaxis as a bundle component was particularly impactful, being associated with a significant reduction in infection risk. These findings reinforce the importance of multimodal and standardized approaches in SSI prevention.
Paranhos et al. (2026) studied this question.