Introduction: Glioblastoma multiforme (GBM) is a primary glial neoplasm with a median survival of approximately one year. There are anecdotal reports that postoperative infection may confer a survival advantage in patients with GBM. However, only a few case reports in the literature, along with two retrospective cohort studies show some potential link between infection and prolonged survival in GBM patients. The objective of this study was to evaluate the effect of postoperative infection in patients with GBM using a large national database.

Methods: The linked Surveillance, Epidemiology, and End Results (SEER) – Medicare database was searched to identify patients, 66 years and older with GBM with and without infection from 1997-2010. The primary outcome was survival after diagnosis. The statistical analysis was performed with a graphical representation by Kaplan Meier curves, a univariate analysis with the log-rank test and multivariate analysis with the proportional hazard modeling.

Results: 3,784 patients with GBM were identified from the database, and from these, 369 patients (9.8%) had postoperative infection. In GBM patients who had an infection within one-month of surgery, there was no difference in survival (5 months) compared to patients with no infection (6 months) (P=0.17). We also showed that older age, increased Gagne comorbidity score, and having diabetes may be negatively associated with survival.

Conclusions: Infection after craniotomy within one-month was not associated with a survival benefit in patients with GBM.

Patient Care: By encouraging surgeons to continue avoiding postoperative infection in GBM patients, as our study of 3784 patients showed no benefit in survival in patients who had a postoperative infection.

Learning Objectives: By the conclusion of this session, participants should be able to: understand that there is likely no survival benefit to having an infection within one-month of GBM resection despite the fact that the possibility is still often discussed amongst surgeons.

References: 1. Bohman LE, Gallardo J, Hankinson TC, Waziri AE, Mandigo CE, McKhann GM, et al: The survival impact of postoperative infection in patients with glioblastoma multiforme. Neurosurgery 64(5):828-834, 2019 2. Bonis PD, Albanese A, Lofrese G, Waure CD, Mangiola A, Pettorini BL, et al: Postoperative infection may influence survival in patients with glioblastoma: simply a myth? Neurosurgery 69:864-869, 2011