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Relationship between characteristics of glioma treatment and surgical site infections

  • Original Article - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Purpose

Surgical site infections (SSIs) after neurosurgery are common in daily practice. Although numerous reports have described SSIs in neurosurgery, reports specific to gliomas are limited. This study aimed to investigate the relationship between SSIs and glioma treatment characteristics, such as reoperations, radiation therapy, and chemotherapy.

Methods

We examined 1012 consecutive patients who underwent craniotomy for glioma between November 2013 and March 2022. SSIs were defined as infections requiring reoperation during the observation period, regardless of their location. We retrospectively analyzed SSIs and patient factors.

Results

During the observation period, SSIs occurred in 3.1% (31/1012). In the univariate analysis, three or more surgeries (P = 0.007) and radiation therapy (P = 0.03) were associated with SSIs, whereas intraoperative magnetic resonance imaging (MRI) was not significantly associated (P = 0.35). Three or more surgeries and radiation therapy were significantly correlated with each other (P < .0001); therefore, they were analyzed separately in the multivariate analysis. Three or more surgeries were an independent factor triggering SSIs (P = 0.02); in contrast, radiation therapy was not an independent factor for SSIs (P = 0.07). Several SSIs localized in the skin occurred more than 1 year after surgery.

Conclusions

Undergoing three or more surgeries for glioma is an independent risk factor for SSIs. Glioma SSIs can occur long after surgery. These results are considered characteristic of gliomas. We recommend careful long-term observation of patients at a high risk of SSIs.

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References

  1. Bekelis K, Coy S, Simmons N (2016) Operative duration and risk of surgical site infection in neurosurgery. World Neurosurg 94:551-555.e556. https://doi.org/10.1016/j.wneu.2016.07.077

    Article  PubMed  Google Scholar 

  2. Berghmans M, de Ghellinck L, De Greef J, Di Santo M, Ribeiro Vaz JG, Zech F, Belkhir L (2022) Outcome of patients with surgical site infection after craniotomy. Surg Infect (Larchmt) 23:388–393. https://doi.org/10.1089/sur.2021.260

    Article  PubMed  Google Scholar 

  3. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, Reinke CE, Morgan S, Solomkin JS, Mazuski JE, Dellinger EP, Itani KMF, Berbari EF, Segreti J, Parvizi J, Blanchard J, Allen G, Kluytmans J, Donlan R, Schecter WP (2017) Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 152:784–791. https://doi.org/10.1001/jamasurg.2017.0904

    Article  PubMed  Google Scholar 

  4. Bohman LE, Gallardo J, Hankinson TC, Waziri AE, Mandigo CE, McKhann GM 2nd, Sisti MB, Canoll P, Bruce JN (2009) The survival impact of postoperative infection in patients with glioblastoma multiforme. Neurosurgery 64:828–834. https://doi.org/10.1227/01.Neu.0000343525.89321.C5. (discussion 834-825)

    Article  PubMed  Google Scholar 

  5. Chaichana KL, Kone L, Bettegowda C, Weingart JD, Olivi A, Lim M, Quinones-Hinojosa A, Gallia GL, Brem H (2015) Risk of surgical site infection in 401 consecutive patients with glioblastoma with and without carmustine wafer implantation. Neurol Res 37:717–726. https://doi.org/10.1179/1743132815y.0000000042

    Article  PubMed  Google Scholar 

  6. Chen YR, Ugiliweneza B, Burton E, Woo SY, Boakye M, Skirboll S (2017) The effect of postoperative infection on survival in patients with glioblastoma. J Neurosurg 127:807–811. https://doi.org/10.3171/2016.8.Jns16836

    Article  PubMed  Google Scholar 

  7. Dinevski N, Sarnthein J, Vasella F, Fierstra J, Pangalu A, Holzmann D, Regli L, Bozinov O (2017) Postoperative neurosurgical infection rates after shared-resource intraoperative magnetic resonance imaging: a single-center experience with 195 cases. World Neurosurg 103:275–282. https://doi.org/10.1016/j.wneu.2017.03.093

    Article  PubMed  Google Scholar 

  8. Dormand EL, Banwell PE, Goodacre TE (2005) Radiotherapy and wound healing. Int Wound J 2:112–127. https://doi.org/10.1111/j.1742-4801.2005.00079.x

    Article  PubMed  PubMed Central  Google Scholar 

  9. Haubner F, Ohmann E, Pohl F, Strutz J, Gassner HG (2012) Wound healing after radiation therapy: review of the literature. Radiat Oncol 7:162. https://doi.org/10.1186/1748-717x-7-162

    Article  PubMed  PubMed Central  Google Scholar 

  10. Korinek AM (1997) Risk factors for neurosurgical site infections after craniotomy: a prospective multicenter study of 2944 patients. The French Study Group of Neurosurgical Infections, the SEHP, and the C-CLIN Paris-Nord Service Epidémiologie Hygiène et Prévention. Neurosurgery 41:1073–1079. https://doi.org/10.1097/00006123-199711000-00010. (discussion 1079-1081)

    Article  CAS  PubMed  Google Scholar 

  11. Korinek AM, Golmard JL, Elcheick A, Bismuth R, van Effenterre R, Coriat P, Puybasset L (2005) Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4,578 patients. Br J Neurosurg 19:155–162. https://doi.org/10.1080/02688690500145639

    Article  PubMed  Google Scholar 

  12. Lietard C, Thébaud V, Besson G, Lejeune B (2008) Risk factors for neurosurgical site infections: an 18-month prospective survey. J Neurosurg 109:729–734. https://doi.org/10.3171/jns/2008/109/10/0729

    Article  PubMed  Google Scholar 

  13. McClelland S 3rd, Hall WA (2007) Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis 45:55–59. https://doi.org/10.1086/518580

    Article  PubMed  Google Scholar 

  14. Mollman HD, Haines SJ (1986) Risk factors for postoperative neurosurgical wound infection. A case-control study J Neurosurg 64:902–906. https://doi.org/10.3171/jns.1986.64.6.0902

    Article  CAS  PubMed  Google Scholar 

  15. Morshed RA, Young JS, Gogos AJ, Haddad AF, McMahon JT, Molinaro AM, Sudhakar V, Al-Adli N, Hervey-Jumper SL, Berger MS (2022) Reducing complication rates for repeat craniotomies in glioma patients: a single-surgeon experience and comparison with the literature. Acta Neurochir (Wien) 164:405–417. https://doi.org/10.1007/s00701-021-05067-9

    Article  PubMed  Google Scholar 

  16. Muragaki Y, Iseki H, Maruyama T, Kawamata T, Yamane F, Nakamura R, Kubo O, Takakura K, Hori T (2006) Usefulness of intraoperative magnetic resonance imaging for glioma surgery. Acta Neurochir Suppl 98:67–75. https://doi.org/10.1007/978-3-211-33303-7_10

    Article  CAS  PubMed  Google Scholar 

  17. Olascoaga A, Vilar-Compte D, Poitevin-Chacón A, Contreras-Ruiz J (2008) Wound healing in radiated skin: pathophysiology and treatment options. Int Wound J 5:246–257. https://doi.org/10.1111/j.1742-481X.2008.00436.x

    Article  PubMed  PubMed Central  Google Scholar 

  18. Salle H, Deluche E, Couvé-Deacon E, Beaujeux AC, Pallud J, Roux A, Dagain A, de Barros A, Voirin J, Seizeur R, Belmabrouk H, Lemnos L, Emery E, Fotso MJ, Engelhardt J, Jecko V, Zemmoura I, Le Van T, Berhouma M, Cebula H, Peyre M, Preux PM, Caire F (2021) Surgical site infections after glioblastoma surgery: results of a multicentric retrospective study. Infection 49:267–275. https://doi.org/10.1007/s15010-020-01534-0

    Article  PubMed  Google Scholar 

  19. Spratt DE, Folkert M, Zumsteg ZS, Chan TA, Beal K, Gutin PH, Pentsova E, Yamada Y (2014) Temporal relationship of post-operative radiotherapy with temozolomide and oncologic outcome for glioblastoma. J Neurooncol 116:357–363. https://doi.org/10.1007/s11060-013-1302-4

    Article  CAS  PubMed  Google Scholar 

  20. Uzuka T, Takahashi H, Nakasu Y, Okuda T, Mitsuya K, Hayashi N, Hirose T, Kurai H (2017) Surgical site infection after malignant brain tumor resection: a multicenter study for induction of a basic care bundle. Neurol Med Chir (Tokyo) 57:542–547. https://doi.org/10.2176/nmc.oa.2017-0034

    Article  PubMed  Google Scholar 

  21. Valentini LG, Casali C, Chatenoud L, Chiaffarino F, Uberti-Foppa C, Broggi G (2008) Surgical site infections after elective neurosurgery: a survey of 1747 patients. Neurosurgery 62:88–95. https://doi.org/10.1227/01.Neu.0000311065.95496.C5. (10.1227/01.Neu.0000311065.95496.C5)

    Article  PubMed  Google Scholar 

  22. Wach J, Goetz C, Shareghi K, Scholz T, Heßelmann V, Mager AK, Gottschalk J, Vatter H, Kremer P (2019) Dual-use intraoperative MRI in glioblastoma surgery: results of resection, histopathologic assessment, and surgical site infections. J Neurol Surg A Cent Eur Neurosurg 80:413–422. https://doi.org/10.1055/s-0039-1692975

    Article  PubMed  Google Scholar 

  23. Wallace DJ, McGinity MJ, Floyd JR 2nd (2018) Bone flap salvage in acute surgical site infection after craniotomy for tumor resection. Neurosurg Rev 41:1071–1077. https://doi.org/10.1007/s10143-018-0955-z

    Article  PubMed  Google Scholar 

  24. Wathen C, Kshettry VR, Krishnaney A, Gordon SM, Fraser T, Benzel EC, Modic MT, Butler S, Machado AG (2016) The association between operating room personnel and turnover with surgical site infection in more than 12 000 neurosurgical cases. Neurosurgery 79:889–894. https://doi.org/10.1227/neu.0000000000001357

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Neurosurgery, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan

    Atsushi Kuwano, Taiichi Saito, Masayuki Nitta, Shunsuke Tsuzuki, Shunichi Koriyama, Yoshihiro Muragaki & Takakazu Kawamata

  2. Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women’s Medical University, Tokyo, Japan

    Atsushi Kuwano, Taiichi Saito, Manabu Tamura, Soko Ikuta, Ken Masamune & Yoshihiro Muragaki

Authors
  1. Atsushi Kuwano
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  2. Taiichi Saito
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  3. Masayuki Nitta
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  4. Shunsuke Tsuzuki
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  10. Takakazu Kawamata
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Corresponding author

Correspondence to Taiichi Saito.

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Ethical approval

Ethical approval was obtained from the ethics committee at Tokyo Women’s Medical University (No. 3540).

Informed consent

Given the retrospective design of the study, the institutional review board waived the requirement for informed consent. To protect patient privacy, we removed all identifiers from our records upon completion of our analyses.

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The authors declare no competing interests.

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Kuwano, A., Saito, T., Nitta, M. et al. Relationship between characteristics of glioma treatment and surgical site infections. Acta Neurochir 165, 659–666 (2023). https://doi.org/10.1007/s00701-022-05474-6

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  • DOI: https://doi.org/10.1007/s00701-022-05474-6

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