Cranioplasty Complications and Costs: A National Population-Level Analysis Using the MarketScan Longitudinal Database.
OBJECTIVE
To characterize cranioplasty complications and costs at a population level using a longitudinal national claims database.


METHODS
We identified patients undergoing cranioplasty between 2007 and 2014 in the MarketScan national database. We evaluated age, autograft usage, cranioplasty size, and cranioplasty timing stratified by postoperative outcomes. We further analyzed associated costs. A subset analysis of adult patients with emergent indications, including stroke and trauma, was performed.


RESULTS
We identified 8275 patients (mean age 44.0 years ± 20.0, 45.2% male), including 13.8% children (<18 years old), 76.0% adults (18-64 years old), and 10.2% elderly adults (≥65 years old). Overall complication rate was 36.6%, mortality rate was 0.5%, and 30-day readmission rate was 12.0%. Elderly patients had the highest complication rate (P < 0.0001). Large cranioplasties (>5 cm) had higher complication rates than small cranioplasties (≤5 cm; P = 0.047). In patients with emergent indications (n = 1282), size did not influence complications, although large cranioplasties showed higher infection risk (P = 0.02). Autograft use did not affect outcomes but was associated with higher complication risk, including infections, in the subset with emergent indications (P < 0.001, P = 0.001). Late (>90 days) cranioplasty timing had higher complication rates in the overall cohort and the subset with emergent indications (P < 0.001, P < 0.001). Index costs of care were mainly driven by hospital payments in both the overall cohort and the cohort with emergent indications.


CONCLUSIONS
A high complication rate is associated with cranioplasty in the United States. Older age, large cranioplasties, and delayed cranioplasties increased complication risk overall. Among patients with emergent indications, complications were associated with delayed time to cranioplasty and autograft usage.
Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA. Electronic address: amyli88@stanford.edu.
Amy
A
Li
Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA.
Tej Deepak
TD
Azad
Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA.
Anand
A
Veeravagu
Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA.
Inderpreet
I
Bhatti
Division of Plastic & Reconstructive Surgery, Stanford Health Care, Stanford, California, USA.
Chao
C
Long
Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA.
John K
JK
Ratliff
Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA. Electronic address: gordonli@stanford.edu.
Gordon
G
Li
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
Complication; Cost; Cranioplasty; MarketScan; Population; Timing