Predictors and clinical implications of surgical site infections following glioma resection: a matched case-control study.

Abstract

<h4>Introduction</h4>Surgical site infections (SSIs) are uncommon but clinically significant complications following glioma resection, often disrupting postoperative recovery and delaying adjuvant therapy. These patients are particularly susceptible due to several disease- and treatment-related factors. However, data on SSI predictors, outcomes, and optimal management remain limited.<h4>Methods</h4>We retrospectively reviewed 733 adult primary and recurrent glioma patients who underwent surgical resection between 2009 and 2024. Thirty-six patients with SSIs were matched 1:4 to 144 controls by age and gender. Predictors were evaluated using Cox proportional hazards regression. Overall survival was assessed using Kaplan-Meier and log-rank tests.<h4>Results</h4>SSI incidence was 4.9%, with a median onset of 35 days. On multivariable analysis, prior radiotherapy (HR: 3.92 [1.69-9.13], p < 0.001) and postoperative CSF leak (HR: 10.33 [3.7-28.8], p = 0.006) were independently associated with increased SSI risk. No significant survival difference was observed between SSI and non-SSI groups (p = 0.21). Immediate mesh cranioplasty, performed in 6 cases, demonstrated comparable outcomes to delayed cranioplasty and autologous bone replacement, with no recurrence or increased complication rates.<h4>Conclusion</h4>Postoperative CSF leak and prior radiotherapy are independent risk factors for SSIs after glioma resection. Although SSIs did not adversely impact overall survival, timely recognition and effective management remain critical. Immediate mesh cranioplasty appears to be a safe and effective option in appropriately selected cases. Further research is warranted to establish standardized guidelines for managing infected bone flaps in this population.