Predictors of surgical site infection in glioblastoma patients undergoing craniotomy for tumor resection

Abstract

OBJECTIVE Surgical site infections (SSIs) burden patients and healthcare systems, often requiring additional intervention. The objective of this study was to identify the relationship between preoperative predictors inclusive of scalp incision type and postoperative SSI following glioblastoma resection. METHODS The authors retrospectively reviewed cases of glioblastoma resection performed at their institution from December 2006 to December 2019 and noted preoperative demographic and clinical presentations, excluding patients missing these data. Preoperative nutritional indices were available for a subset of cases. Scalp incisions were categorized as linear/curvilinear, reverse question mark, trapdoor, or frontotemporal. Patients were dichotomized by SSI incidence. Multivariable logistic regression was used to determine predictors of SSI. RESULTS A total of 911 cases of glioblastoma resection were identified, 30 (3.3%) of which demonstrated postoperative SSI. There were no significant differences in preoperative malnutrition or number of surgeries between SSI and non-SSI cases. The SSI cases had a significantly lower preoperative Karnofsky Performance Status (KPS) than the non-SSI cases (63.0 vs 75.1, p < 0.0001), were more likely to have prior radiation history (43.3% vs 26.4%, p = 0.042), and were more likely to have received steroids both preoperatively and postoperatively (83.3% vs 54.5%, p = 0.002). Linear/curvilinear incisions were more common in non-SSI than in SSI cases (56.9% vs 30.0%, p = 0.004). Trapdoor scalp incisions were more frequent in SSI than non-SSI cases (43.3% vs 24.2%, p = 0.012). On multivariable analysis, a lower preoperative KPS (OR 1.04, 95% CI 1.02–1.06), a trapdoor scalp incision (OR 3.34, 95% CI 1.37–8.49), and combined preoperative and postoperative steroid administration (OR 3.52, 95% CI 1.41–10.7) were independently associated with an elevated risk of postoperative SSI. CONCLUSIONS The study findings indicated that SSI risk following craniotomy for glioblastoma resection may be elevated in patients with a low preoperative KPS, a trapdoor scalp incision during surgery, and steroid treatment both preoperatively and postoperatively. These data may help guide future operative decision-making for these patients.

Comprehensive analysis of risk factors and pathogenetic characteristics associated with surgical site infections following craniotomy procedures

“…However, our study extends the analysis by including a broader range of factors like ASA grades and emergency surgeries, offering a more comprehensive risk profile. Nair et al 22 identified low Karnofsky Performance Status, trapdoor scalp incisions and steroid use as predictors for SSIs in glioblastoma patients, similar to our emphasis on patient-related risk factors. Our research complements this by providing additional insights into operative factors and the impact of surgical techniques on SSI risk.…”

Predicted factors of surgical site infection in glioblastoma patients: A meta‐analysis

“…Whereas little is known about the specific risk factors following surgery for glioblastoma. Reported risk factors for wound complications in glioblastoma patients are older age, implantation of carmustine wafers, diabetes mellitus, KPS and combined preoperative and postoperative steroid administration and so on 10,12,13 . This meta‐analysis evaluated the risk factors for SSI after craniotomy in glioblastoma patients.…”

“…Reported risk factors for wound complications in glioblastoma patients are older age, implantation of carmustine wafers, diabetes mellitus, KPS and combined preoperative and postoperative steroid administration and so on. 10 , 12 , 13 This meta‐analysis evaluated the risk factors for SSI after craniotomy in glioblastoma patients. A total of 4 studies with 2222 samples were selected in the analysis.…”

“…Predicted factors related to SSI following craniotomy in glioblastoma patients explored by previous studies include implantation of carmustine wafers, 10 postoperative irradiation or prior radiation history, 11 , 12 , 13 more than 3 surgeries, 11 , 12 decreased Karnofsky Performance Status (KPS), 12 combined preoperative and postoperative steroid administration. 12 Whereas big differences in research results exist, and the correlation coefficients of different research results are quite different. In addition, little is known about the predicted factors related to SSI in glioblastoma patients following craniotomy.…”