Does Plastic Surgery Involvement Decrease Complications After Cranioplasty? A Retrospective Cohort Study

Abstract

To compare postoperative outcomes after cranioplasties performed by neurosurgery only (N) versus neurosurgery and plastic surgery combined (N+P). A single-center, multi-surgeon, retrospective cohort study was undertaken on all cranioplasties performed from 11/2006-12/2021. The primary exposure variable was operating team (N vs. N+P). The primary outcome was the need for reoperation. Secondary outcomes included surgical site infections, complications, length of stay (LOS), and length of drain placement. Of 188 patients undergoing cranioplasty during the study period, 106(56%) patients were in the N group, and 82(44%) in the N+P group. Patient demographics were similar between the two groups. For the primary outcome, a total of 20(18.9%) reoperations were seen in the N group, and 13(15.9%) in the N+P group (p=0.708). However, the median time to reoperation was slightly longer in the N+P group in the survival analysis. Wound dehiscence (1.9% vs. 3.7%,p=0.454), surgical site infection (5.7% vs. 9.8%,p=0.289) and complication rate (30.2% vs. 32.9%,p=0.688) did not differ between the two groups. Furthermore, N group had less JP drain use (58.5% vs. 85.4%,p<0.001), earlier drain removal (1.9±1.6 vs. 3.4±3.9days, p<0.001), and shorter LOS (3.8±5.9 vs 4.7±3.9days, p<0.001). On multivariate regression analysis controlling for age, BMI, smoking, craniectomy type, reason for craniectomy, and graft type, N+P was associated with increased drain use (OR=4.90, 95%CI=2.28-11.30, p<0.001) and longer drain duration (β=1.50, 95%CI=0.43-2.60, p=0.007). Despite similar complication and reoperation rates between groups, reoperations in the N group occurred sooner, whereas N+P group more commonly used drains and kept drains in for longer.