Adverse financial and clinical burden of the use of prophylactic antibiotics in neurosurgical patients.

Background: Current guidance does not support the administration of prophylactic antibiotics in non-infected post-operative surgical cases including neurosurgery. Materials and methods: This paper is a qualitative assessment, highlighting the economic cost of excessive antimicrobial prescription and the healthcare costs of the extra days of admission in hospital. Results: One hundred and one neurosurgical cases were analysed in a single institution over a one-year period. The additional course of post-operative antibiotics has a cost of £56.72 and receiving prolonged post-operative antibiotics added on average £1121.10 to their admission bill. Up to 13.4 patients may have experienced an adverse drug event. Conclusion: This paper reinforces the adherence to guidelines can aid in the reduction of adverse drug events, improve patient outcomes, and reduce costs associated with unnecessary drug prescriptions and administration.

The Environmental Footprint of Neurosurgery Operations: An Assessment of Waste Streams and the Carbon Footprint.

Healthcare in England generates 24.9 million tonnes of carbon dioxide equivalents (CO2e), equating to approximately 4% of the total national output of greenhouse gases (GHG), and of this, 10% is from the manufacturing of medical equipment. Operating theatres are a major contributor of biomedical waste, especially consumables, and are three-to-six times more energy intensive than the rest of the hospital. This study seeks to quantify and evaluate the carbon cost, or footprint, of neurosurgery at a single institution in England. A single neurosurgical operation generates, on average, 8.91 kg of waste per case, equivalent to 24.5 CO2e kg per case, mostly from single-use equipment. Per annum, 1300 neurosurgical operative cases are performed with total waste generation of 11,584.4 kg/year and a carbon footprint of 31,859 (kg) CO2e. The challenge of achieving net zero GHG presents an opportunity to catalyse innovation and sustainability in neurosurgery, from how care is delivered, through to equipment use and surgical methodologies. This should improve the quality of healthcare provision to patients and yield potential cost savings.

Ventriculo-peritoneal shunt independence following successful treatment of Gram negative (E. coli) ventriculitis: Case report and review of the literature.

We report a case of tumour-related hydrocephalus in a child treated with a ventriculo-peritoneal shunt which subsequently became infected with gram negative bacteria (Escherichia coli). After successful treatment of the infection the patient became shunt independent and has remained so for over 2 years. Gram negative ventriculitis is associated with diminished cerebro-spinal fluid production and we discuss the literature to date regarding this phenomenon.