Predictors of Postoperative Complications Following Cranioplasty

Cranioplasty is performed to restore the bone flap after previous brain surgery or trauma. Despite its elective nature, patients may be at risk for complications. Our study analyzes predictors of adverse events after cranioplasty and compares outcomes among patients undergoing very-early and standard cranioplasty.

Patients who underwent cranioplasty were retrospectively identified from the TriNetX Research Network. A Cox proportional hazards model was used to assess the risk of mortality, surgical site infection (SSI), and need for revision cranioplasty. Propensity score matching was performed to compare adverse events based on timing of cranioplasty: very-early (≤1 month) and standard (>1 month).

In total, 22 347 patients were included. Risk factors for mortality were being overweight/obese (hazard ratio [HR]: 1.15, 95% CI: 1.04-1.28, P < .01), acute kidney failure/chronic kidney disease (HR: 1.28, 95% CI: 1.15-1.42, P < .001), long-term steroid use (HR: 1.47, 95% CI: 1.24-1.75, P < .0001), and history of opioid-related disorders (HR: 1.29, 95% CI: 1.01-1.65, P < .05). Increasing risk of SSI was observed across different age groups. Risk factors for revision cranioplasty were White race (HR: 0.74, 95% CI: 0.62-0.89, P < .01), diabetes mellitus (HR: 1.22, 95% CI: 1.05-1.42, P < .01), and acute kidney failure/chronic kidney disease (HR: 1.30, 95% CI: 1.11-1.52, P < .001). After propensity score matching, 2223 patients were included in each cohort. The very-early cohort had higher risk for all-cause mortality, use of critical care services, sepsis, pneumonia, urinary tract infection, hydrocephalus, epidural hemorrhage, acute kidney failure, headache, nausea, and vomiting compared with the standard cohort. The very-early cohort also had lower risk for revision cranioplasty, SSI, and infection of prosthetic devices.

Demographic variables, comorbid conditions, and procedure characteristics predict adverse events after cranioplasty. Very-early cranioplasty may carry increased risk for mortality but decreased risk for revisions compared with standard cranioplasty.