Incidence of Surgical Site Infection Requiring Reoperation Following Awake Craniotomy

An awake craniotomy (AC) is performed for cerebral tumors near or involving eloquent regions of the brain to maximize tumor resection whilst preserving neurological function. Reducing the risk of surgical site infections (SSIs) is vital, as infections can delay adjuvant therapy. However, data on SSI requiring reoperation following AC in the United Kingdom remain limited.

We performed a single-center retrospective case series of all AC procedures between January 2015 and April 2023. Data were collected from the electronic health record on surgical indication, demographics, repeat surgeries, and intraoperative details. Surgical site infections requiring re-operation (SSI-R) were identified through theatre records, microbiology results, and clinical notes. Infection rates were compared with patients undergoing asleep craniotomies during the same period.

A total of 131 ACs were performed on 109 patients. Six cases were complicated by SSI-R (4.6%; n = 6). Five out of six patients had glioblastoma, IDH-wildtype (WHO grade 4), whilst four involved ventricular breach during resection; four patients' infections also occurred after redo oncology surgery. No significant preoperative comorbidities were identified. In comparison, 19 infections occurred among asleep craniotomy cases (3.0%), which was not statistically significant (odds ratio 1.57, 95% confidence interval 0.61-4.00; P = 0.413). Tumor grade reached statistical significance in the awake group.

Over an 8-year period, the SSI-R rate was 4.6%, comparable to asleep craniotomy. There was an association with glioblastoma, redo surgery and breaching the ventricle during resection, concomitant with known risk factors for infection following cranial neurosurgery.