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: Rafael Stein Rosseto, Alexandre Varella Giannetti, Lucidio Duarte de Souza Filho, Rodrigo Moreira Faleiro
• Journal: World neurosurgery (World Neurosurg) Vol. 84 Issue 2 Pg. 431-7 (Aug 2015) ISSN: 1878-8769 [Electronic] United States
• PMID: 25841754 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Bone Cements
• Polymethyl Methacrylate

Topics

• Adolescent
• Adult
• Aged
• Bone Cements
• Child
• Decompressive Craniectomy (adverse effects)
• Female
• Glasgow Outcome Scale
• Humans
• Incidence
• Logistic Models
• Male
• Middle Aged
• Polymethyl Methacrylate
• Plastic Surgery Procedures (adverse effects)
• Retrospective Studies
• Risk Factors
• Surgical Flaps
• Surgical Wound Infection (epidemiology)
• Young Adult