Surgical Site Infections in Glioblastoma Patients—A Retrospective Analysis

Abstract

Surgical site infections (SSIs) after craniotomy lead to additional morbidity and mortality for patients, which are related to higher costs for the healthcare system. Furthermore, SSIs are associated with a longer hospital stay for the patient, which is particularly detrimental in glioblastoma patients due to their limited life expectancy. Risk factors for SSIs have already been described for craniotomies in general. However, there is limited data available for glioblastoma patients. As postoperative radiation influences wound healing, very early radiation is suspected to be a risk factor for SSI. Nevertheless, there are no data on the optimal timing of radiotherapy. To define risk factors for these patients, we analyzed our collective. We performed a retrospective analysis of all operations with histological evidence of a glioblastoma between 2012 and 2021. Open biopsy and tumor removal (gross total resection, subtotal resection) were included. Stereotactic biopsies were excluded. Demographic data such as age and gender, as well as duration of surgery, diameter of the trepanation, postoperative radiation with interval, postoperative chemotherapy, highest blood glucose level, previous surgery, ASA score, foreign material introduced, subgaleal suction drainage, ventricle opening and length of hospital stay, were recorded. The need for surgical revision due to infection was registered as an SSI. A total of 177 patients were included, of which 14 patients (7.9%) suffered an SSI. These occurred after a median of 45 days. The group with SSIs tended to include more men (57.1%, p = 0.163) and more pre-operated patients (50%, p = 0.125). In addition, foreign material and subgaleal suction drains had been implanted more frequently and the ventricles had been opened more frequently, without reaching statistical significance. Surprisingly, significantly more patients without SSIs had been irradiated (80.3%, p = 0.03). The results enable a better risk assessment of SSIs in glioblastoma patients. Patients with previous surgery, introduced foreign material, subgaleal suction drain and opening of the ventricle may have a slightly higher for SSIs. However, because none of these factors were significant, we should not call them risk factors. A less radical approach to surgery potentially involving these factors is not justified. The postulated negative role of irradiation was not confirmed, hence a rapid chemoradiation should be induced to achieve the best possible oncologic outcome.

Comparable survival in rats with intracranial glioblastoma irradiated with single-fraction conventional radiotherapy or FLASH radiotherapy

“…Also, radiation ulcers and infections can lead to long-term problems ( 21 ). In glioblastoma patients, it has been suggested that early initiation of radiotherapy might increase the risk for surgical site infections due to wound healing problems ( 22 ). With the early evaluation of dermal side effects already two weeks after irradiation, acute dermal side effects were covered.…”

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

“…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.…”

“…Surgery remains the primary treatment for glioblastoma. 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.…”