Medical Student Penn State College of Medicine Hershey, Pennsylvania, United States
Disclosure(s):
Debarati Bhanja, BS: No financial relationships to disclose
Introduction: Postoperative complications following cranioplasty occur in nearly 30% of patients requiring decompressive craniectomy. Controversy exists regarding the procedure’s timing, particularly whether performing cranioplasty closer to or further from the craniectomy reduces morbidity. Both strategies offer distinct benefits and associated risks; however, the literature remains inconclusive regarding complication rates in the postoperative period.
Methods: This retrospective cohort study used TriNetX database to gather clinical data from 37 healthcare organizations. Patients were identified as undergoing early (0 to 90 days) or late (91 days to 1 year) cranioplasty following craniectomy. Propensity score adjustment matched cohorts on demographics, significant comorbidities, and anticoagulant use. Postoperative outcomes, such as seizures, intracerebral hemorrhage, hydrocephalus, and infection were measured within 6 months following cranioplasty. Complication rates were compared between groups using unadjusted odds ratios and 95% confidence intervals (OR, 95% CI). Kaplan Meier survival analysis and log-rank tests were used to compare mortality.
Results: A total of 2,761 patients were included in this analysis (1,140 early; 1,621 late). Mean age at cranioplasty was 43 years, and patients were predominantly male (67%). After matching, 994 patients remained in each cohort. Patients undergoing early cranioplasty had significantly higher likelihood of developing intracerebral hemorrhage (OR, 2.06; 1.05-4.05) and hydrocephalus (OR, 1.76; 1.05-2.96). Frequencies of seizure (16.39% vs. 12.59%; OR, 1.36; 0.97-1.91), wound infection (7.64% vs. 6.13%; OR, 1.27; 0.89-1.80), and intracranial infection (2.33% vs. 1.12%; OR, 2.11; 0.99-4.5) were higher in the early cohort compared to the late cohort. On survival analysis, six-month mortality rate was significantly higher in patients with early cranioplasty compared to late (OR, 2.11; 1.32-3.37; p=0.0007).
Conclusion : These findings suggest that deferring cranioplasty for at least 90 days may reduce postoperative morbidity and mortality. Nonetheless, cranioplasty timing appears to be implicated in outcomes, and prospective studies that involve patient selection and patient goals are needed to validate these results.
