Autologous cranioplasty is associated with increased re-operation rate: A systematic review and meta-analysis.

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Autologous cranioplasty is associated with increased re-operation rate: A systematic review and meta-analysis.

World Neurosurg. 2018 May 10;:

Authors: Malcolm JG, Mahmooth Z, Rindler RS, Allen JW, Grossberg JA, Pradilla G, Ahmad FU

Abstract
OBJECTIVE: Consensus regarding selection of synthetic versus autologous flap reimplantation for cranioplasty after decompressive craniectomy has not been reached and the multiple factors considered for each patient make comparative analysis challenging. This study examines the association between choice of material and related complications.
METHODS: A systematic literature review and meta-analysis was performed using PubMed for articles reporting delayed cranioplasty after decompressive craniectomy using a cohort design comparing autologous bone and synthetic implants. Extracted data included implant material and incidence of infection, reoperations related to implant, wound complications, and resorption.
RESULTS: One randomized controlled trial and eleven cohort studies were included for a total of 1586 implants (950 bone, 636 synthetic). Autologous implants had significantly more reoperations than synthetic implants (n=1586 implants, odds ratio [OR] 1.91, 95% confidence interval [CI] 1.40-2.61). Reoperations were most often due to resorption (54%, n=159/295) followed by infection (41%, n=121/295). The pooled incidence of resorption in autologous implants was 20% (n=159/791). Among the other outcomes, there was no significant difference for infections (n=1586, OR 1.24, CI 0.82-1.88) or wound complications (n=678, OR 0.56, CI 0.22-1.45). For the trauma subpopulation, there was no significant difference in infection rate with either material (n=197, OR 1.89, CI 0.59-6.09).
CONCLUSIONS: Autologous implants had significantly more reoperations due primarily to the intrinsic risk of resorption (Level of Evidence 3b).

PMID: 29753896 [PubMed - as supplied by publisher]

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