Independent factors affecting postoperative complication rates after custom-made porous hydroxyapatite cranioplasty: a single-center review of 109 cases.

Independent factors affecting postoperative complication rates after custom-made porous hydroxyapatite cranioplasty: a single-center review of 109 cases.

World Neurosurg. 2018 Apr 03;:

Authors: Still M, Kane A, Roux A, Zanello M, Dezamis E, Parraga E, Sauvageon X, Meder JF, Pallud J

Abstract
BACKGROUND: Cranioplasties are an important neurosurgical procedure not only for improved cosmesis, but also for improved functional recover after craniectomy with a large cranial defect. The aim of this study was to identify predictive factors of post-cranioplasty complications using custom-made porous hydroxyapatite cranioplasty.
METHODS: A retrospective review was conducted of all patients who underwent a reconstructive cranioplasty using custom-made hydroxyapatite at our institution between February 2008 to September 2017. Postoperative complications considered included bacterial infection, seizures, hydrocephalus requiring ventricular shunt placement, and cranioplasty-to-bone shift. Variables associated at the p<0.1 level in unadjusted analysis were entered into backward stepwise logistic regression models.
RESULTS: One hundred and nine patients were included. Fifteen patients (13.8%) experienced postoperative infection, with craniectomy performed in an outside institution (adjusted OR, 10.37 [95%CI:2.03-75.27], p=0.012), and a previous infection at the surgical site (adjusted OR, 6.15 [95%CI:1.90-19.92], p=0.003) identified as independent predictors. Six patients (5.5%) experienced postoperative seizures, with stroke (both ischemic and hemorrhagic) as a reason for craniectomy (adjusted OR, 11.68 [95%CI:2.56-24.13], p<0.001), and the presence of seizures in the month prior to cranioplasty (adjusted OR, 9.39 [95%CI:2.04-127.67], p=0.002) identified as independent predictors. Four patients (3.7%) experienced post-cranioplasty hydrocephalus necessitating a shunt placement and 5 patients (4.6%) experienced cranioplasty-to-bone shift ≥5mm, but no significant predictive factors were identified for either complication.
CONCLUSIONS: The aim was to identify possible predictive factors for post-cranioplasty complications in order help identify at-risk patients, guide prophylactic care, and improve morbidity of this important surgical procedure.

PMID: 29625304 [PubMed - as supplied by publisher]

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