title: Complications of cranioplasty after decompressive craniectomy for traumatic brain injury.
abstract: BACKGROUND
  Decompressive craniectomy (DC)--a potentially life-saving intervention following traumatic brain injury (TBI) with medically refractory brain swelling--once performed, surviving patients, more often than not, undergo a second procedure with cranioplasty (CP) in the future. This study analyzes complications following CP after DC, as the beneficial effects of the DC can't be extrapolated in long run over a population unless one adds into it the complications associated with the CP in the survivors of TBI.
  
  
  METHODS
  An observational study was performed retrospectively, with the review of case records. Demographic, clinical, and outcome data were collected, and complications were studied for any predictive parameters. A multivariate analysis was performed to identify factors that influenced these complications.
  
  
  RESULTS
  Data were collected for a total of 74 patients who underwent CP with a median age of 32, and a mean follow-up time of 2 years and 8 months. The mortality rate was 1.35% and overall complication rate 31%. The most significant factor determining complications were operating time more than 90 min Odds ratio (OR) 4.77 (1.61-14.20); timing of CP less than 3 months after craniectomy, OR 2.86 (1.48-8.11); age more than 20 years, OR 2.59 (1.20-6.53); and female gender, OR 1.91 (1.13-4.17).
  
  
  CONCLUSIONS
  Although considered as a straight-forward procedure, the risks associated with this elective procedure should be kept in mind by the surgeon so that the patients and families can be apprised judiciously. It should be ascertained that patient and/or family consents for the procedure after being appropriately informed about the benefits and risks associated with the procedure.
authors.affiliation: a Department of Neurosurgery , NIMHANS , Bengaluru , India.
authors.forename: Jitender
authors.initials: J
authors.lastname: Chaturvedi
authors.affiliation: b Department of Clinical Neurosciences , NIMHANS , Bengaluru , India.
authors.forename: Ragasudha
authors.initials: R
authors.lastname: Botta
authors.affiliation: a Department of Neurosurgery , NIMHANS , Bengaluru , India.
authors.forename: A R
authors.initials: AR
authors.lastname: Prabhuraj
authors.affiliation: a Department of Neurosurgery , NIMHANS , Bengaluru , India.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Shukla
authors.affiliation: a Department of Neurosurgery , NIMHANS , Bengaluru , India.
authors.forename: Dahnanjay I
authors.initials: DI
authors.lastname: Bhat
authors.affiliation: a Department of Neurosurgery , NIMHANS , Bengaluru , India.
authors.forename: B Indira
authors.initials: BI
authors.lastname: Devi
mesh_terms: D000293:Adolescent; D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D056424:Decompressive Craniectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: complications; cranioplasty; decompressive craniectomy