Wang H, He YL, Gao Y, Gao XR, Sun LY, Yan JC, Lu Q, Ni KW. Risk factors for surgical site infection after craniotomy for meningioma resection in a tertiary hospital in China. World J Clin Oncol 2026; 17(8): 122421 [DOI: 10.5306/wjco.122421]
Corresponding Author of This Article
Kai-Wen Ni, PhD, Department of Infection Control, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou 310009, Zhejiang Province, China. nkw721@zju.edu.cn
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Surgery
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Wang H, He YL, Gao Y, Gao XR, Sun LY, Yan JC, Lu Q, Ni KW. Risk factors for surgical site infection after craniotomy for meningioma resection in a tertiary hospital in China. World J Clin Oncol 2026; 17(8): 122421 [DOI: 10.5306/wjco.122421]
World J Clin Oncol. Aug 24, 2026; 17(8): 122421 Published online Aug 24, 2026. doi: 10.5306/wjco.122421
Risk factors for surgical site infection after craniotomy for meningioma resection in a tertiary hospital in China
Hong Wang, Yu-Lu He, Yin Gao, Xing-Rong Gao, Li-Yuan Sun, Ji-Cheng Yan, Qun Lu, Kai-Wen Ni
Hong Wang, Yu-Lu He, Yin Gao, Xing-Rong Gao, Li-Yuan Sun, Ji-Cheng Yan, Qun Lu, Kai-Wen Ni, Department of Infection Control, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Author contributions: Wang H drafted manuscript; Wang H, Yan JC, Lu Q, and Ni KW designed the study; He YL, Gao Y, Gao XR, and Sun LY assisted with data collection and preparation; Yan JC, Lu Q, and Ni KW supervised the project and provided critical revision of manuscript; and all authors reviewed and approved the final version of the manuscript.
AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Supported by the National Natural Science Foundation of China, No. 72504249.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine, approval No. (2026) 0381.
Informed consent statement: The informed consent was waived by the Institutional Review Board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Corresponding author: Kai-Wen Ni, PhD, Department of Infection Control, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou 310009, Zhejiang Province, China. nkw721@zju.edu.cn
Received: April 20, 2026 Revised: June 30, 2026 Accepted: July 28, 2026 Published online: August 24, 2026 Processing time: 128 Days and 17.7 Hours
Abstract
BACKGROUND
Meningioma is the most common intracranial neoplasm and carries a non-negligible surgical site infection (SSI) risk (reported incidence: 4%-6%) despite its clean-wound classification. Most existing studies enroll heterogeneous neurosurgical cohorts spanning vascular, traumatic, and biologically distinct tumor entities, even though meningioma itself is an independent SSI risk factor, which calls for disease-specific investigation. Preoperative host physiologic reserve indices have shown prognostic value across oncology and neurosurgery, yet remain unevaluated as predictors of SSI after meningioma resection in Chinese cohorts. We hypothesized that precisely measured surgery time and preoperative immune-nutritional status are associated with SSI risk in this population.
AIM
To examine modifiable factors associated with SSI after meningioma resection, focusing on precisely measured surgery time and preoperative immune-nutritional indices.
METHODS
A 1:4 matched case-control study was conducted at a tertiary neurosurgical center between January 2022 and November 2025, with matching on age, sex, and year of surgery. SSI was defined according to United States Centers for Disease Control and Prevention criteria. Surgery time was defined as the interval from skin incision to wound closure. Preoperative indices, including neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index, nutritional risk index, and modified frailty index, were extracted from routine clinical assessments. Least Absolute Shrinkage and Selection Operator regression followed by conditional logistic regression was used, with restricted cubic splines examining the dose-response relationship between surgery time and SSI risk.
RESULTS
Longer surgery time was independently associated with SSI (odds ratio = 1.824 per hour; 95% confidence interval: 1.405-2.369), with a threshold of 3.04 hours beyond which SSI risk increased 5.7-fold. Preoperative NLR was also independently associated with SSI risk (odds ratio = 1.081; 95% confidence interval: 1.007-1.159). The model showed good discrimination (area under the curve = 0.828) with acceptable calibration.
CONCLUSION
Longer surgery time and elevated preoperative NLR are associated with SSI after meningioma resection. A 3.04-hours threshold offers a practical criterion for prospective risk stratification.
Core Tip: This disease-specific case-control study is among the first to systematically evaluate preoperative host physiologic reserve indices - including the modified frailty index, nutritional risk index, neutrophil-to-lymphocyte ratio, and prognostic nutritional index - as predictors of surgical site infection following meningioma resection in a Chinese neurosurgical cohort. Using precisely measured operative time (skin incision to wound closure) and Least Absolute Shrinkage and Selection Operator-informed multivariable modeling, we identified a 3.04-hour operative threshold beyond which surgical site infection risk increases 5.7-fold, and established preoperative neutrophil-to-lymphocyte ratio as an independent immune-nutritional predictor. These findings provide clinically actionable criteria for prospective risk stratification and targeted perioperative optimization.
