title: Risk Factors for Graft Infection After Cranioplasty in Patients with Large Hemicranial Bony Defects.
abstract: OBJECTIVE
  To identify infection incidence and related risk factors in patients who underwent cranioplasty (CP) after unilateral decompressive craniectomy (DC).
  
  
  METHODS
  CP after DC was performed in 45 patients from April 2011 through January 2012. The covariates studied were compared with occurrence versus nonoccurrence of infection. Univariate analysis was performed, followed by a multivariate analysis and development of independent logistic regression models with significance of 5%.
  
  
  RESULTS
  Wound infections were observed in 24% of cases. Patients treated with polymethyl methacrylate flaps had a 31% rate of infection compared with 12% in patients treated with autologous flaps, but the difference was not statistically significant (P = 0.279). Increased risk of infection was associated with performing CP during the same period of hospitalization as DC (45% vs. 8%; P = 0.006), recent systemic infection (53% vs. 10%; P = 0.003), a Glasgow Outcome Scale score lower than 4 (48% vs. none; P < 0.001), motor deficit (42% vs. 5%; P = 0.011), and lower levels of hemoglobin (P < 0.001). Another risk factor for infection was an interval between DC and CP of 29-84 days compared with >168 days (P = 0.007).
  
  
  CONCLUSIONS
  The incidence of wound infection was high. Risk factors included motor deficits, Glasgow Outcome Scale score <4, lower hemoglobin levels, recent systemic infections, interval between DC and CP of 29-84 days, and DC and CP performed during the same hospitalization. Performing CP during a different hospitalization may reduce the risk of graft infection because the hemoglobin level would be higher, and patients would be less dependent and free of recent infection.
authors.affiliation: Department of Surgery, School of Medicine, Universidade Federal de Minas Gerais, Minas Gerais, Brazil; Neurosurgery Service, Hospital Pronto-Socorro João XXIII, Belo Horizonte, Minas Gerais, Brazil. Electronic address: rafaelsteinrosseto@yahoo.com.br.
authors.forename: Rafael Stein
authors.initials: RS
authors.lastname: Rosseto
authors.affiliation: Department of Surgery, School of Medicine, Universidade Federal de Minas Gerais, Minas Gerais, Brazil; Neurosurgery Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil.
authors.forename: Alexandre Varella
authors.initials: AV
authors.lastname: Giannetti
authors.affiliation: Neurosurgery Service, Hospital Pronto-Socorro João XXIII, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Lucidio Duarte
authors.initials: LD
authors.lastname: de Souza Filho
authors.affiliation: Neurosurgery Service, Hospital Pronto-Socorro João XXIII, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Rodrigo Moreira
authors.initials: RM
authors.lastname: Faleiro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001843:Bone Cements; D002648:Child; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate
keywords: Cranioplasty; Decompressive craniectomy; Infection; Risk factors