Weill Cornell Medical College, New York, NY, USA.
Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA.
J Neurooncol. 2023 Apr;162(2):337-342. doi: 10.1007/s11060-023-04294-7. Epub 2023 Mar 29.
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.
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.
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).
Risk factors in aggregate incrementally increase the risk of postoperative SSI after craniotomy for tumor.
本研究旨在阐述手术部位感染（SSI）的病因，并探讨其在神经肿瘤病理患者行颅切开术后感染率中的组合效应。
纳入 2006 年至 2020 年间接受神经肿瘤颅切开术的患者。回顾病历以确定术后≤3 个月时伤口感染的发生情况。感染的潜在危险因素包括肿瘤病理、位置、麻醉类型、适应证、脑室进入、异物、近距离放疗、腰椎引流、既往手术、既往颅部放疗、既往感染、贝伐单抗和医学合并症（高血压、肥胖、糖尿病、高血脂、其他癌症、肝硬化）。实施逻辑回归以确定 SSI 的危险因素。卡方检验用于评估与危险因素较少的患者相比，危险因素的数量（例如，0、≥1、≥2、≥3、≥4）是否增加 SSI 的风险。还评估了每个额外危险因素的相对增加。
共纳入 1209 例患者。术后 90 天内，42 例（3.5%）患者发生 SSI。多变量逻辑回归的显著危险因素包括贝伐单抗（OR 40.84；p<0.001）、肝硬化（OR 14.20，p=0.03）、异物放置（OR 4.06；P<0.0001）、既往放疗（OR 2.20；p=0.03）和既往手术（OR 1.92；p=0.04）。组合分析中的感染率如下：≥1 个危险因素=5.9%（OR 2.74；p=0.001），≥2 个危险因素=6.7%（OR 2.28；p=0.01），≥3 个危险因素=19.0%（OR 6.5；p<0.0001），≥4 个危险因素=100%（OR 30.2；p<0.0001）。
危险因素的综合作用会逐渐增加肿瘤患者颅切开术后 SSI 的风险。
