OBJECTIVE To systematically analyze the risk factors for surgical site infection (SSI) after craniotomy and provide evidence-based support for SSI prevention and control.

METHODS Databases in Chinese and English, including CNKI, Wanfang, VIP, CBM, PubMed, Embase, Cochrane Library and Web of Science, were searched from the establishment of the databases to Jun. 2025 to collect literature related to SSI after craniotomy. After literature screening, the quality of the literature was assessed with the Newcastle-Ottawa Scale (NOS), and data analysis was performed with RevMan 5.3 software.

RESULTS A total of 15 literatures involving 36 042 subjects were finally included. The meta-analysis results showed that five risk factors were significantly associated with SSI after craniotomy, including gender (male) (OR=1.23, 95%CI: 1.09 to 1.38, P < 0.001), emergency surgery (OR=2.04, 95%CI: 1.10 to 3.79, P=0.020), secondary surgery (OR=3.44, 95%CI: 1.82 to 6.50, P < 0.001), cerebrospinal fluid leakage (OR=13.11, 95%CI: 5.09 to 33.77, P < 0.001) and postoperative indwelling drainage tube (OR=3.42, 95%CI: 1.62 to 7.18, P=0.001).

CONCLUSIONS SSI after craniotomy poses a significant hazard to patients, and various factors can contribute to its occurrence and development. Clinically, it is necessary to focus on the prevention and control of high-risk factors, such as strengthening the prevention of cerebrospinal fluid leakage and standardized management of drainage tubes, optimizing emergency/secondary surgery procedures, and enhancing perioperative monitoring of male patients, in order to effectively reduce the incidence rate of SSI after craniotomy in the neurosurgery.