Predictors of Surgical Site Infection Following Craniotomy for Intracranial Neoplasms: An Analysis of Prospectively Collected Data in the American College of Surgeons National Surgical Quality Improvement Program Database

Abstract

Objective: To determine the rate of surgical site infection (SSI) after resection of an intracranial neoplasm using the American College of Surgeons National Surgical Quality Improvement Program data set and to identify potential risk factors associated with SSI.

Methods: The National Surgical Quality Improvement Program Participant Use Data File was queried during the period 2006-2013 for patients who underwent a resection for an intracranial neoplasm. Multivariable logistic regression analysis was used to identify risk factors associated with SSI.

Results: Inclusion criteria were met by 12,021 patients. SSI occurred at a rate of 2.04%. SSI was significantly associated with increased rates of return to the operating room (56.1% vs. 4.0%, P < 0.001) and postoperative lengths of stay >30 days (5.3% vs. 1.3%, P < 0.001) on unadjusted bivariate analysis. On multivariable analysis, age (odds ratio [OR] = 0.991, 95% confidence interval [CI] = 0.982-0.999) and female sex (OR = 0.697, 95% CI = 0.538-0.902) were associated with a reduction in the odds of SSI. Preoperative wound infections (OR = 3.833, 95% CI = 1.834-8.0011) and operative times >4 hours (OR = 1.891, 95% CI = 1.298-2.756) were associated with an increased odds of SSI. Among cases with available chemotherapy data (n = 3504), recent chemotherapy (OR = 3.007, 95% CI = 1.460-6.196) was associated with an increased odds of SSI.

Conclusions: This study identified patient risk factors that may assist clinical decision making regarding patient risk stratification, timing of surgery, and preoperative antibiotic prophylaxis for patients with an intracranial neoplasm undergoing craniotomy.

Keywords: Craniotomy; NSQIP; Predictors; Surgical site infection.