What question did this study set out to answer?

The aim is to identify predictors of wound dehiscence and infection post-craniotomy using a large clinical database.

February 26, 2026

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

Key Points

The aim is to identify predictors of wound dehiscence and infection post-craniotomy using a large clinical database.
Analyzed data from the NSQIP database for 24,235 craniotomy cases (2018-2022).
Conducted multivariate logistic regression to assess predictors of complications.
Examined age, functional status, steroid use, albumin levels, and ASA classification as potential predictors.
Age and preoperative steroid use were significant predictors of wound dehiscence.
Steroid use raised the risk of dehiscence (odds ratio 3.27).
Functional status significantly correlated with wound infection risk, especially in dependent patients.
Longer intervals from preoperative albumin testing to surgery increased infection risk (odds ratio 1.81).
Patients with higher ASA classification faced greater risks for infection.

Abstract

Introduction: 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. Materials and Methods: 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. Results: 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). Conclusions: 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.

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