Introduction: Complication rates following cranioplasty (CP) approach 37% in both the plastic surgery and neurosurgery literature. With significant heterogeneity regarding the risk and complications of cranial reconstructive surgery, a single-institution, single-surgeon outcome review and systematic analysis was conducted to identify clinical predictors of significance and to evaluate association with patient-specific risk factors.
Methods: A retrospective review was performed of an IRB-approved database spanning January 2012 to March 2018. CP cases were grouped for comparison based on referral pattern. Major, minor, and infectious complication rates were calculated and each risk factor was analyzed in multivariate logistics regression.
Results: 440 consecutive CPs were performed between January 2012 and March 2018 and detailed within the database. Overall, we found an 8% (18/227) complication rate for all patients with no history of prior CP for their index cranial defect treated at our center (i.e. defined as having their first CP with senior author and therefore categorized as “direct primary”). With the inclusion of all “revision” surgeries thereafter, these ‘direct’ patients experienced a major complication rate of 9% (23/245). Alternatively, the major complication rate for patients “referred” to the senior author - after previous failed CP surgery - was 24% (38/161) following their first CP and 30% (58/195) overall. Multivariate analysis of this 440 patient cohort revealed statistically significant independent correlations for major complications along with the number of previous failed CP attempts, patient BMI, and amount of previous scalp-incision surgeries. Infectious complications were found at a rate of 10% for all cases and were significantly higher among the “referred” group as compared to the “direct” groups (18% vs. 4%, p<0.001) and were more likely to occur in “revision” versus “primary” CP cases (17 % vs. 4%, p<0.001).
Conclusion: These results suggest that cranioplasties in this cohort performed initially, with no previous attempt, had a five-fold reduction in overall complications when compared to the literature (37% vs 8%) (1). Further research is warranted to confirm that designated centers concentrating on neuro-cranial reconstruction (i.e. cranioplasty) may provide an overall cost benefit with improved outcomes and decreased complications.