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Clinical Practice Changes Reduce Resorbable Plate-Associated Wound Complications in Cranial Vault Reconstructive
Emily A Panteli1, Frank O F Reilly1, Shirley Bracken1
1National Paediatric Craniofacial Centre, Children's Health Ireland at Temple Street, Dublin.
Background:
Complications post-cranial vault reconstruction surgery can be associated with significant morbidity. Our institution previously reported a 12.1% (22 of 182) wound complication rate, requiring readmission to the hospital with a 9.9% (18 of 182) reoperation rate following the use of resorbable PLGA plates. Following this, our clinical practice changes were implemented, including greater consideration given to preoperative sterilization of the surgical field, including attention to the amount of hair shaved preoperatively; double skin preparation in theatre using chlorhexidine and betadine. Intraoperatively, the minimum quantity and size of resorbable plates are used. Plate placement close to the wound closure site is avoided. This study examined whether these changes in clinical practice resulted in lower resorbable plate-associated wound complications.
Methods:
A retrospective comparative study of patients before and after the clinical practice changes was conducted. Patient demographics, operative, and postoperative details were compared. Continuous data were described using means and standard deviations (SD) for normally distributed data and compared using independent samples t tests. Non-normal data were described using medians and interquartile ranges and compared using Mann-Whitney U tests. Differences in categorical data were described using counts, percentages, and χ 2 or Fisher's exact test as appropriate. Data were analyzed using SPSS Version 28.
Results:
A total of 75 patients underwent surgery between 2018 and 2021, with 5.3% (4 of 75) of patients experiencing resorbable plate-associated wound complications. There were no significant differences between the 2 cohorts regarding gender, age, or weight at the time of surgery. The proportion of patients requiring readmission was significantly lower following the introduction of clinical practice changes [4.0% (3/75) versus 12.1% (22/182), P =0.033].
Conclusions:
In conclusion, 4 changes in our clinical practice introduced at our institution in 2018 with the aim of reducing our wound complication rates post-CVR have resulted in a significant reduction in wound complications requiring readmission among patients with craniosynostosis.
