Behind the Scalp: Predictors of Wound Dehiscence and Wound Infection After Craniotomy-An Analysis of 24,235 Cases

Craniotomy is a commonly performed neurosurgical procedure for tumor removal, vascular repair, and decompression. While generally safe, postoperative wound complications remain a major concern due to their proximity to the central nervous system. Adjuvant therapies, particularly radiation, can impair scalp healing by causing fibrosis, poor microcirculation, and reduced epithelial repair, thereby predisposing patients to wound dehiscence and surgical site infection (SSI). These complications increase morbidity, length of stay, and readmissions, with SSI following glioblastoma surgery accounting for nearly one-third of rehospitalizations.

This study analyzed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify predictors of wound complications after craniotomy. A total of 24,235 cases from 2018 to 2022 were reviewed. Multivariate logistic regression was used to evaluate predictors of wound dehiscence and infection.

Age and preoperative steroid use emerged as significant predictors of wound dehiscence, with steroid exposure associated with a higher risk [odds ratio (OR) 3.27, P=0.00012], whereas increasing age conferred a modest protective effect (OR 0.97, P=0.004). For wound infection, independent predictors included poor functional status (partially dependent: OR 3.66; totally dependent: OR 7.97; P=0.00008), steroid use (OR 1.85, P=0.013), longer intervals from preoperative albumin testing to surgery (OR 1.81, P=0.031), and higher ASA class, with ASA IV patients at greatest risk compared with ASA II and III (OR 2.63 and 1.87, respectively).

These findings highlight functional status, perioperative steroid use, albumin levels, and ASA classification as key determinants of postoperative wound outcomes after craniotomy, underscoring the importance of tailored risk assessment and optimization strategies.