title: Analysis of Factors Contributing to Infections After Cranioplasty: A Single-Institution Retrospective Chart Review.
abstract: OBJECTIVE
  Cranioplasty is one of the most common neurosurgical procedures, yet has one of the greatest rates of infection among cranial operations. Although studies have reported on cranioplasty complications, it is unclear what factors contribute to the high rate of infection. This study aims to determine which patient characteristics and operative factors lead to postcranioplasty infections.
  
  
  METHODS
  This was a retrospective chart review of 186 patients. Factors analyzed included sex, reason for cranioplasty, type of infection, medical comorbidities, and surgical factors.
  
  
  RESULTS
  The overall infection rate was 24%. Skin flora was the most common pathogen. Wound dehiscence and presence of a postoperative fluid collection were associated significantly with a greater rate of infection (P < 0.001), whereas the use of autologous bone flap and a state of immunosuppression trended toward statistical significance (P = 0.075 and P = 0.089, respectively). Male sex, history of previous infection, history of craniectomy for trauma, cranioplasty size, and time to cranioplasty were not found to be significant factors related to cranioplasty infection.
  
  
  CONCLUSIONS
  Although wound dehiscence and postoperative fluid collections were associated significantly with infection in this study, the number in each sample size was small, and further studies with a larger number of patients in each subgroup is necessary to validate our findings.
authors.affiliation: Department of Neurosurgery, SUNY-Upstate Medical University, Syracuse, New York, USA. Electronic address: mriorda2@stanford.edu.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Riordan
authors.affiliation: Department of Neurosurgery, SUNY-Upstate Medical University, Syracuse, New York, USA.
authors.forename: Venita M
authors.initials: VM
authors.lastname: Simpson
authors.affiliation: Department of Neurosurgery, SUNY-Upstate Medical University, Syracuse, New York, USA.
authors.forename: Walter A
authors.initials: WA
authors.lastname: Hall
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications; D002557:Cerebrospinal Fluid Shunts; D015897:Comorbidity; D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012867:Skin / Q000382:microbiology; D013524:Surgical Flaps / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology
keywords: Cranioplasty; Decompressive craniectomy; Immunosuppression; Postoperative infection