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Which One Is Better to Reduce the Infection Rate, Early or Late Cranioplasty? | LitMetric

AI Article Synopsis

  • Decompressive craniectomy effectively reduces high intracranial pressure, but the timing of subsequent cranioplasty is debated due to concerns about infection risks.
  • A study analyzed 131 patients to compare early (within 90 days) and late (after 90 days) cranioplasty regarding infection rates and identified risk factors.
  • Results indicated that early cranioplasty had a lower infection rate (7%) compared to late (20%), with non-metal allograft materials and younger age posing significant infection risks.

Article Abstract

Objective: Decompressive craniectomy is an effective therapy to relieve high intracranial pressure after acute brain damage. However, the optimal timing for cranioplasty after decompression is still controversial. Many authors reported that early cranioplasty may contribute to improve the cerebral blood flow and brain metabolism. However, despite all the advantages, there always remains a concern that early cranioplasty may increase the chance of infection. The purpose of this retrospective study is to investigate whether the early cranioplasty increase the infection rate. We also evaluated the risk factors of infection following cranioplasty.

Methods: We retrospectively examined the results of 131 patients who underwent cranioplasty in our institution between January 2008 and June 2015. We divided them into early (≤90 days) and late (>90 days after craniectomy) groups. We examined the risk factors of infection after cranioplasty. We analyzed the infection rate between two groups.

Results: There were more male patients (62%) than female (38%). The mean age was 49 years. Infection occurred in 17 patients (13%) after cranioplasty. The infection rate of early cranioplasty was lower than that of late cranioplasty (7% vs. 20%; p=0.02). Early cranioplasty, non-metal allograft materials, re-operation before cranioplasty and younger age were the significant factors in the infection rate after cranioplasty (p<0.05). Especially allograft was a significant risk factor of infection (odds ratio, 12.4; 95% confidence interval, 3.24-47.33; p<0.01). Younger age was also a significant risk factor of infection after cranioplasty by multivariable analysis (odds ratio, 0.96; 95% confidence interval, 0.96-0.99; p=0.02).

Conclusion: Early cranioplasty did not increase the infection rate in this study. The use of non-metal allograft materials influenced a more important role in infection in cranioplasty. Actually, timing itself was not a significant risk factor in multivariate analysis. So the early cranioplasty may bring better outcomes in cognitive functions or wound without raising the infection rate.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028610PMC
http://dx.doi.org/10.3340/jkns.2016.59.5.492DOI Listing

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