123 How Early Is Too Early for Cranioplasty Following Craniectomy? A Propensity-Matched Study

Abstract

INTRODUCTION: Nearly 30% of patients experience complications following cranioplasty after decompressive craniectomy. However, the optimal timing for this procedure is not well established. METHODS: Using the TriNetX Research Network, we included patients who underwent either late cranioplasty (91 days to 1 year), or cranioplasty in the first (1-30 days), second (31-60 days), or third (61-90 days) month after craniectomy. Propensity score matching was used to match the late cranioplasty group separately with the other three cranioplasty groups based on demographics, comorbidities, anticoagulant/antiplatelet use, and laboratory values. Postoperative outcomes were assessed within six months after cranioplasty. RESULTS: We analyzed 2545 patients. After matching, 301 patients remained in the first-month, 314 in the second-month, and 406 in the third-month group. The prevalence of postoperative complications, including seizures/epilepsy, infections, wound disruption, intracranial/intraspinal abscess/granuloma, repeat craniectomy/craniotomy, removal/replacement of bone flap/prosthetic plate of skull, and dependence on wheelchair/care provider were similar across all groups. Compared to late cranioplasty, intracerebral hemorrhage was significantly more common in the first-month (p = 0.033) and second-month (p = 0.01) groups, but not in the third-month (p = 0.502) group. Epidural hemorrhage was significantly more common in the second-month (p = 0.0492) group, while subdural hemorrhage was significantly more common in all early cranioplasty groups. Meningitis/Encephalitis/myelitis/encephalomyelitis were significantly more common only in the first-month group (p = 0.009). Hydrocephalous was significantly more common only in the second-month group (p = 0.0046). The need for repeat cranioplasty was significantly higher in the first-month (p = 0.005) and second-month (p = 0.043) groups. Mortality rate was significantly higher in the first-month (p = 0.004) and second-month (p = 0.02) groups. CONCLUSIONS: Cranioplasty in the first 60 days following craniectomy is associated with increased postoperative morbidity and mortality. Prospective studies are needed to establish the best timing for cranioplasty.