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Prognostic nomogram for predicting postoperative meningitis duration in skull base tumor surgery: a retrospective
Ruofei Yuan1, Hai Peng1, Ying Wang2
11Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; and.
Objective:
Postoperative meningitis (PM) is a severe complication following skull base tumor surgery, often resulting in prolonged hospitalization and increased morbidity. However, predicting the duration of PM remains challenging. This study aimed to identify prognostic factors influencing the duration of PM and to develop a predictive nomogram to guide individualized management and antibiotic therapy.
Methods:
The authors conducted a retrospective cohort study of patients diagnosed with PM after skull base tumor surgery at a high-volume neurosurgical center between December 2018 and August 2024. Patients who received antibiotic treatment were included. Logistic regression analysis was performed to identify independent predictors of prolonged meningitis duration (> 7 and > 14 days). Based on these factors, predictive nomograms were developed and validated to estimate the probability of extended recovery times.
Results:
Among 629 patients with PM, 240 (38%) experienced meningitis > 7 days and 69 (11%) had durations > 14 days. Multivariate analysis identified fever duration (> 38.5°C), highest CSF white blood cell (WBC) count, lowest CSF glucose level, highest blood WBC count, highest blood neutrophilic granulocyte proportion, repeat operation, and surgical approach as independent predictors of prolonged meningitis. The nomogram demonstrated good predictive performance, with concordance indices of 0.80 (95% CI 0.74-0.83) for the 7-day model and 0.79 (95% CI 0.70-0.85) for the 14-day model in the training cohort. Calibration curves and decision curve analyses further confirmed the accuracy and clinical utility of the models.
Conclusions:
The authors successfully developed and validated a prognostic nomogram to predict the duration of PM following skull base tumor surgery. This tool enables individualized risk stratification, informs the optimal duration of antibiotic therapy, and supports improved postoperative management. Prospective studies are warranted to further validate these findings across broader clinical settings.
Insights
This study developed a nomogram to predict postoperative meningitis (PM) duration after skull base surgery. It identifies key factors to guide personalized treatment and antibiotic therapy for better patient outcomes.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Oncology
Background:
- Postoperative meningitis (PM) is a serious complication after skull base tumor surgery, leading to longer hospital stays and increased patient morbidity.
- Predicting the exact duration of PM is difficult, complicating treatment decisions and resource allocation.
Purpose of the Study:
- To identify prognostic factors associated with the duration of postoperative meningitis (PM).
- To develop and validate a predictive nomogram for estimating PM duration to guide individualized patient management and antibiotic strategies.
Main Methods:
- Retrospective cohort study of 629 patients with PM following skull base tumor surgery.
- Logistic regression analysis identified independent predictors of prolonged meningitis (> 7 and > 14 days).
- Predictive nomograms were developed and validated using concordance indices, calibration curves, and decision curve analyses.
Main Results:
- Fever duration, CSF/blood WBC counts, CSF glucose, blood neutrophilic granulocyte proportion, repeat operations, and surgical approach were significant predictors of prolonged PM.
- The developed nomograms showed good predictive performance (Concordance Index 0.80 for 7-day, 0.79 for 14-day models).
- Nomogram accuracy and clinical utility were confirmed through calibration and decision curve analyses.
Conclusions:
- A validated prognostic nomogram can accurately predict PM duration after skull base tumor surgery.
- This tool aids in individualized risk stratification and optimizing antibiotic therapy duration.
- Further prospective studies are recommended to validate findings in diverse clinical settings.
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