Predicting and reducing cranioplasty infections by clinical, radiographic and operative parameters – A historical cohort study. (December 2016)

• Record Type: Journal Article
• Authors: Kimchi, Gil; Stlylianou, Petros; Wohl, Anton; Hadani, Moshe; Cohen, Zvi R.; Zauberman, Jacob; Feldman, Zeev; Spiegelmann, Roberto; Nissim, Ouzi; Zivly, Zion; Penn, Mark; Harnof, Sagi
• Is Part Of: Journal of clinical neuroscience. Volume 34(2016:Dec.)
• Page Start: 182
• Page End: 186
• Publication Date: 2016-12
• Subjects: Cranioplasty -- Infection -- Modified Rankin Score; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2016.06.007
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Cranioplasty is a common procedure that carries an abnormally high rate of infection. The authors assessed the effect of various variables on the risk of infection. Pre-operative degree of neurological disability was the strongest of all predictors. Cranial trauma and autologous grafts were trends toward a higher risk for infection. Careful patient selection is a key concept in avoiding harmful infections. 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.