Incidence of Meningitis in Patients Undergoing Decompressive Craniectomy at Shaheed Mohtarma Benazir Bhutto Institute of Trauma Center, Karachi

Background: Meningitis remains a significant postoperative complication in neurosurgical patients, particularly following decompressive craniectomy (DC), which is often performed to manage elevated intracranial pressure due to trauma, stroke, or mass lesions. Despite the life-saving potential of DC, limited regional data exist regarding the incidence and predictors of postoperative meningitis in such patients. Objective: To determine the incidence of postoperative meningitis and its association with cerebrospinal fluid (CSF) abnormalities in patients undergoing decompressive craniectomy at the Shaheed Mohtarma Benazir Bhutto Institute of Trauma Center, Karachi. Methods: This cross-sectional observational study included 150 adult patients (n = 150) who underwent DC for various neurosurgical indications. Patients with pre-existing meningitis or lost to follow-up were excluded. Data were collected on demographic variables, comorbidities, preoperative status, CSF analysis, and clinical signs of meningitis. Ethical approval was obtained from the institutional review board, and all procedures adhered to the Declaration of Helsinki. Statistical analysis was performed using SPSS version 25, with a significance level set at p < 0.05. Results: The incidence of clinical meningitis was 10% (15/150). Abnormal CSF findings were significantly associated with meningitis (p = 0.02), with 42.9% of patients with abnormal CSF developing infection compared to 8.4% with normal CSF. No significant associations were observed with surgical indication, preoperative condition, or comorbidities. Conclusion: Postoperative meningitis is a clinically relevant complication in DC patients, with CSF abnormalities serving as a significant predictive marker. These findings emphasize the importance of early CSF monitoring and targeted antibiotic strategies to improve neurosurgical outcomes.