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Additive risk of surgical site infection from more than one risk factor following craniotomy for tumor

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Abstract

Purpose

This study seeks to expound upon risk factor etiologies for surgical site infection (SSI) and investigate their combinatorial effects on infection rate following craniotomy for neuro-oncologic pathology.

Methods

Patients who underwent neuro-oncologic craniotomy between 2006 and 2020 were included. Medical records were reviewed to identify the occurrence of wound infection at ≤ 3 months postoperatively. Potential risk factors for infection included tumor pathology, location, anesthesia type, indication, ventricular entry, foreign body, brachytherapy, lumbar drain, prior operation, prior cranial radiation, prior infection, bevacizumab, and medical comorbidities (hypertension, obesity, diabetes, hyperlipidemia, other cancer, cirrhosis). Logistic regression was implemented to determine risk factors for SSI. Chi-square tests were used to assess whether the number of risk factors (e.g., 0, ≥ 1, ≥2, ≥ 3, ≥4) increases the risk of SSI compared to patients with fewer risk factors. The relative increase with each additional risk factor was also evaluated.

Results

A total of 1209 patients were included. SSI occurred in 42 patients (3.5%) by 90 days after surgery. Significant risk factors on multivariate logistic regression were bevacizumab (OR 40.84; p < 0.001), cirrhosis (OR 14.20, p = 0.03), foreign body placement (OR 4.06; P < 0.0001), prior radiation (OR 2.20; p = 0.03), and prior operation (OR 1.92; p = 0.04). Infection rates in the combinatorial analysis were as follows: ≥1 risk factor = 5.9% (OR 2.74; p = 0.001), ≥ 2 = 6.7% (OR 2.28; p = 0.01), ≥ 3 = 19.0% (OR 6.5; p < 0.0001), ≥ 4 = 100% (OR 30.2; p < 0.0001).

Conclusions

Risk factors in aggregate incrementally increase the risk of postoperative SSI after craniotomy for tumor.

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Data availability

The datasets generated or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

Jason Chua, MPH and Paul Christos, DrPH, were partially supported by the following grant: Clinical and Translational Science Center at Weill Cornell Medical College (1-UL1-TR002384-01).

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Authors and Affiliations

  1. Weill Cornell Medical College, New York, NY, USA

    Omri Maayan, Miguel E. Tusa Lavieri & Christopher Babu

  2. Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA

    Jason Chua & Paul J. Christos

  3. Department of Neurological Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th St, Box #99, New York, NY, 10065, USA

    Theodore H. Schwartz

Authors
  1. Omri Maayan
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  2. Miguel E. Tusa Lavieri
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  3. Christopher Babu
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  4. Jason Chua
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  5. Paul J. Christos
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  6. Theodore H. Schwartz
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Contributions

All authors contributed to study conception, material preparation, and data collection/analysis. The manuscript was written by OM and THS. All authors commented on previous versions of the manuscript, as well as approved the final manuscript.

Corresponding author

Correspondence to Theodore H. Schwartz.

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Competing interests

The authors report no conflict of interest concerning the materials, methods, or findings specified in this study.

Ethics approval and patient consent

This is a retrospective cohort study. The Institutional Review Board at NewYork-Presbyterian Hospital-Weill Cornell Medicine has confirmed that no ethical approval or patient consent was required (IRB 0606008601).

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Maayan, O., Tusa Lavieri, M.E., Babu, C. et al. Additive risk of surgical site infection from more than one risk factor following craniotomy for tumor. J Neurooncol 162, 337–342 (2023). https://doi.org/10.1007/s11060-023-04294-7

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  • DOI: https://doi.org/10.1007/s11060-023-04294-7

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