A retrospective cohort of 1,148 drug-resistant-epilepsy patients compared 616 single-use with 532 ethylene-oxide-sterilized reused subdural grids. Reuse was not significantly associated with infection after adjustment, and seizure outcomes and complications were similar, but the design does not prove safety equivalence.
Key findings
- Reuse was not independently associated with infection (adjusted OR 0.61; 95% CI 0.37-1.01; p=0.054). Longer surgery was associated with infection (aOR 1.22 per hour; 95% CI 1.05-1.41; p=0.010). One-year seizure outcomes (p=0.802) and complications did not significantly differ.
Why this matters globally
With validated quality systems, reuse could reduce cost and expand epilepsy-surgery access. Decisions must comply with device regulation, integrity testing, reuse-cycle tracking, and sterilization control.
Thai researcher contribution
The Phramongkutklao Hospital neurosurgical team used 18 years of experience and a large cohort to address access to costly technology in the Thai setting.
Limitations to consider
The retrospective single-center 18-year span permits temporal confounding in technique, antibiotics, and selection. Grids chosen for reuse may differ. Absence of significance is not non-inferiority without a margin, and reuse cycles, physical damage, EO residuals, and electrical testing are not described in the abstract.