title: Predictors of cranioplasty complications in stroke and trauma patients.
abstract: OBJECTIVE
  Decompressive craniectomy mandates subsequent cranioplasty. Complications of cranioplasty may be independent of the initial craniectomy, or they may be contingent upon the craniectomy. Authors of this study aimed to identify surgery- and patient-specific risk factors related to the development of surgical site infection and other complications following cranioplasty.
  
  
  METHODS
  A consecutive cohort of patients of all ages and both sexes who had undergone cranioplasty following craniectomy for stroke or trauma at a single institution in the period from May 2004 to May 2012 was retrospectively established. Patients who had undergone craniectomy for infectious lesions or neoplasia were excluded. A logistic regression analysis was performed to model and predict determinants related to infection following cranioplasty.
  
  
  RESULTS
  Two hundred thirty-nine patients met the study criteria. The overall rate of complication following cranioplasty was 23.85% (57 patients). Complications included, predominantly, surgical site infection, hydrocephalus, and new-onset seizures. Logistic regression analysis identified previous reoperation (OR 3.25, 95% CI 1.30-8.11, p = 0.01) and therapeutic indication for stroke (OR 2.45, 95% CI 1.11-5.39, p = 0.03) as significantly associated with the development of cranioplasty infection. Patient age, location of cranioplasty, presence of an intracranial device, bone flap preservation method, cranioplasty material, booking method, and time interval > 90 days between initial craniectomy and cranioplasty were not predictive of the development of cranioplasty infection.
  
  
  CONCLUSIONS
  Cranioplasty complications are common. Cranioplasty infection rates are predicted by reoperation following craniectomy and therapeutic indication (stroke). These variables may be associated with patient-centered risk factors that increase cranioplasty infection risk.
authors: Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. walcott.brian@mgh.harvard.edu
authors: Brian P
authors: BP
authors: Walcott
authors: Churl-Su
authors: CS
authors: Kwon
authors: Sameer A
authors: SA
authors: Sheth
authors: Corey R
authors: CR
authors: Fehnel
authors: Robert M
authors: RM
authors: Koffie
authors: Wael F
authors: WF
authors: Asaad
authors: Brian V
authors: BV
authors: Nahed
authors: Jean-Valery
authors: JV
authors: Coumans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003399:Craniotomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology; D020521:Stroke / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology; D055815:Young Adult