Impact of intraoperative cefazolin on postoperative seizures after elective repair of unruptured cerebral aneurysm

• Published in: American journal of health-system pharmacy Vol. 74; no. 4; pp. 213 - 217
• Main Authors: Rozycki, Alan, Lewin, John J, Tamargo, Rafael, Zink, Betsy, Mirski, Marek, Gibbs, Haley
• Format: Journal Article
• Language: English
• Published: England Copyright American Society of Health-System Pharmacists, Inc. All rights reserved 15.02.2017; American Society of Health-System Pharmacists
• Subjects: Adult; Aged; Aneurysm; Aneurysms; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Antibiotics; Cefazolin; Cefazolin - administration & dosage; Cefazolin - adverse effects; Elective Surgical Procedures - adverse effects; Elective Surgical Procedures - trends; Female; Humans; Intracranial Aneurysm - drug therapy; Intracranial Aneurysm - epidemiology; Intracranial Aneurysm - surgery; Male; Middle Aged; Postoperative Complications - chemically induced; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Prospective Studies; Retrospective Studies; Seizing; Seizures; Seizures - chemically induced; Seizures - diagnosis; Seizures - epidemiology; Surgery; intraoperative care; seizure; intracranial aneurysm; cefazolin
• ISSN: 1079-2082; 1535-2900
• DOI: 10.2146/ajhp160069

PURPOSE.The impact of intraoperative cefazolin on postoperative seizures after elective repair of an unruptured cerebral aneurysm was evaluated. METHODS.Chart review of a prospectively accrued database was performed for patients admitted from January 1, 2003, through December 31, 2013. Patients were included in the study if they underwent elective repair of an unruptured aneurysm with surgical clipping or wrapping. The primary objective was to determine if the use of cefazolin increased patientsʼ odds of having a seizure within six hours of surgical intervention. Univariate comparisons were conducted on all variables for patients who received cefazolin and patients who were treated with other antibiotics. Multivariable logistic regression was performed to assess the impact of cefazolin administered intraoperatively on postoperative seizures, while accounting for other covariates. RESULTS.Of the 520 patients included, 53 (10.2%) patients developed seizures within six hours after surgery. A total of 439 (84.4%) patients received cefazolin intraoperatively. There were no differences in baseline characteristics between the patients who received cefazolin compared with those who did not. The frequency of seizures did not significantly differ between patients treated with cefazolin versus other antibiotics (11.2% versus 4.9%, respectively; p = 0.08). Multivariable regression revealed that the use of cefazolin did not increase the odds of having a seizure postoperatively compared with patients treated with other antibiotics (odds ratio, 2.4; 95% confidence interval, 0.82–7.15). CONCLUSION.No relationship was found between the intraoperative use of cefazolin and the development of seizures during the six hours after the repair of unruptured cerebral aneurysms.