title: Predicting and reducing cranioplasty infections by clinical, radiographic and operative parameters - A historical cohort study.
abstract: Cranioplasty is a relatively straightforward and common procedure, yet it carries a substantial rate of infection that causes major morbidity and mortality. The authors' objective was to assess the effect of various variables on the risk of developing post-cranioplasty infections, and to enable the prediction and reduction of its incidence, contributing to an improved patient-selection. The medical records, microbiologic cultures, imaging studies and operative reports of patients who have undergone cranioplasty between the years 2008-2014 at Sheba Medical Center, a tertiary care teaching hospital in Tel-Hashomer, Israel, were reviewed and evaluated for potential predictive factors of infection. Cox regression was applied for uni- as well as multi-variate analyses, and a Kaplan-Meier curve and Log-Rank test were used to describe the association between neurological deficit prior to operation and occurrence of infection. Eighty-eight patients who had undergone cranioplasties using autologous as well as various artificial materials were included in the study. The overall rate of infection was 13.6%; median time to infection was 30.5 days (interquartile range: 17.35-43.5). Pre-operative degree of neurological disability was the strongest predictor for infection in both uni- and multi-variate analyses (Hazard ratio [HR]=18.9, 95% confidence interval [CI]: 1.9-187 p=0.014). Patients admitted due to trauma (HR=7.04 CI: 0.9-54.6, p=0.062) and autologous graft material (HR=2.88, 95% CI: 0.92-9.09, p=0.07) were associated with a trend toward a higher risk for infection. In conclusion, careful patient selection is a key concept in avoiding harmful post-cranioplasty infections. Modified Rankin Score yields a well-established tool that predicts the risk of infection.
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel. Electronic address: gilkimchi1@gmail.com.
authors.forename: Gil
authors.initials: G
authors.lastname: Kimchi
authors.affiliation: Department of Neurosurgery, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Petros
authors.initials: P
authors.lastname: Stlylianou
authors.affiliation: Department of Neurosurgery, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Anton
authors.initials: A
authors.lastname: Wohl
authors.affiliation: Department of Neurosurgery, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Hadani
authors.affiliation: Department of Neurosurgery, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Zvi R
authors.initials: ZR
authors.lastname: Cohen
authors.affiliation: Department of Neurosurgery, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Zauberman
authors.affiliation: Department of Neurosurgery, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Zeev
authors.initials: Z
authors.lastname: Feldman
authors.affiliation: Department of Neurosurgery, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Roberto
authors.initials: R
authors.lastname: Spiegelmann
authors.affiliation: Department of Neurosurgery, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Ouzi
authors.initials: O
authors.lastname: Nissim
authors.affiliation: Department of Neurosurgery, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Zion
authors.initials: Z
authors.lastname: Zivly
authors.affiliation: Department of Oral and Maxillofacial Surgery, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Mark
authors.initials: M
authors.lastname: Penn
authors.affiliation: Department of Neurosurgery, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Sagi
authors.initials: S
authors.lastname: Harnof
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D064592:Autografts; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cranioplasty; Infection; Modified Rankin Score