Factors related to failure of autologous cranial reconstructions after decompressive craniectomy

CranioSafe Group

doi:10.1016/j.jcms.2019.02.007

Factors related to failure of autologous cranial reconstructions after decompressive craniectomy

CranioSafe Group

Maxillofacial Surgery (AMC)

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Purpose: Cranioplasty is customary after decompressive craniectomy. Many different materials have been developed and used for this procedure. The ideal material does not yet exist, while complication rates in cranioplasties remain high. This study aimed to determine factors related to autologous bone flap failure. Materials and methods: In this two-center retrospective cohort study, 276 patients underwent autologous bone cranioplasty after initial decompressive craniectomy between 2004 and 2014. Medical records were reviewed regarding patient characteristics and factors potentially related to bone flap failure. Data were analyzed using univariable and multivariable regression analysis. Results: Independent factors related to overall bone flap failure were: duration of hospitalization after decompressive craniectomy [OR: 1.012 (95%CI: 1.003–1.022); p = 0.012], time interval between decompressive craniectomy and cranioplasty [OR: 1.018 (95%CI: 1.004–1.032); p = 0.013], and follow-up duration [OR: 1.034 (95%CI: 1.020–1.047); p < 0.001]. In patients with bone flap infection, neoplasm as initial diagnosis occurred significantly more often (29.2% vs. 7.8%; RD 21.3%; 95%CI 8.4 –38.3%; NNH 5; 95%CI 3 –12) and duration of hospitalization after decompressive craniectomy tended to be longer (means 54 vs. 28 days, MD 26.2 days, 95%CI −8.6 to 60.9 days). Patients with bone flap resorption were significantly younger (35 vs. 43 years, MD 7.7 years, 95%CI 0.8–14.6 years) and their cranial defect size tended to be wider than in patients without bone flap resorption (mean circumference 39 vs. 37 cm; MD 2.4 cm, 95% CI -0.43–5.2 cm) and follow-up duration was significantly longer (44 vs. 14 months, MD 29 months, 95%CI 17–42 months). Conclusion: A neoplasm as initial diagnosis, longer hospitalization after decompressive craniectomy, larger time interval between decompressive craniectomy and cranioplasty, and longer follow-up duration are associated with a higher risk of failure of autologous bone flaps for cranioplasty. Patients with these risk factors may be better served with an early recovery program after decompressive surgery or an alloplastic material for cranioplasty.

Original language	English
Pages (from-to)	1420-1425
Number of pages	6
Journal	Journal of Cranio-Maxillofacial Surgery
Volume	47
Issue number	9
Early online date	16 Feb 2019
DOIs	https://doi.org/10.1016/j.jcms.2019.02.007
Publication status	Published - Sept 2019

Funding

This research is supported by the Dutch Technology Foundation STW (Project Nr. 14326 ; CranioSafe), which is part of the Netherlands Organisation for Scientific Research , and which is partly funded by the Ministry of Economic Affairs . This research is supported by the Dutch Technology Foundation STW (Project Nr. 14326; CranioSafe), which is part of the Netherlands Organisation for Scientific Research, and which is partly funded by the Ministry of Economic Affairs. CranioSafe Group: Collaborators include: A.G. Becking, L. Dubois, L.H.E. Karssemakers, D.M.J. Milstein and S.E.C.M van de Vijfeijken, Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; P.R.A.M. Depauw, Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands; F.W.A. Hoefnagels and W.P. Vandertop, Neurosurgical Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; C.J. Kleverlaan and T.J.A.G. M?nker, Department of Dental Material Sciences, Academic Centre for Dentistry Amsterdam, the Netherlands; T.J.J. Maal, 3D Laboratory of Oral and Maxillofacial Surgery, Amsterdam UMC, University; E. Nout, Department of Oral and Maxillofacial Surgery, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands; M. Riool and S.A.J. Zaat, Department of Medical Microbiology, Amsterdam UMC, University, Amsterdam Infection and Immunity Institute, University of Amsterdam, the Netherlands.

Funders	Funder number
Academic Centre for Dentistry Amsterdam
Department of Dental Material Sciences
Department of Neurosurgery
Elisabeth-TweeSteden Hospital
Universiteit van Amsterdam
Ministerie van Economische Zaken
Nederlandse Organisatie voor Wetenschappelijk Onderzoek
Stichting voor de Technische Wetenschappen	14326

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jcms.2019.02.007

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@article{3bbf39088f674407b79642d9eb0d5a1e,

title = "Factors related to failure of autologous cranial reconstructions after decompressive craniectomy",

abstract = "Purpose: Cranioplasty is customary after decompressive craniectomy. Many different materials have been developed and used for this procedure. The ideal material does not yet exist, while complication rates in cranioplasties remain high. This study aimed to determine factors related to autologous bone flap failure. Materials and methods: In this two-center retrospective cohort study, 276 patients underwent autologous bone cranioplasty after initial decompressive craniectomy between 2004 and 2014. Medical records were reviewed regarding patient characteristics and factors potentially related to bone flap failure. Data were analyzed using univariable and multivariable regression analysis. Results: Independent factors related to overall bone flap failure were: duration of hospitalization after decompressive craniectomy [OR: 1.012 (95%CI: 1.003–1.022); p = 0.012], time interval between decompressive craniectomy and cranioplasty [OR: 1.018 (95%CI: 1.004–1.032); p = 0.013], and follow-up duration [OR: 1.034 (95%CI: 1.020–1.047); p < 0.001]. In patients with bone flap infection, neoplasm as initial diagnosis occurred significantly more often (29.2% vs. 7.8%; RD 21.3%; 95%CI 8.4 –38.3%; NNH 5; 95%CI 3 –12) and duration of hospitalization after decompressive craniectomy tended to be longer (means 54 vs. 28 days, MD 26.2 days, 95%CI −8.6 to 60.9 days). Patients with bone flap resorption were significantly younger (35 vs. 43 years, MD 7.7 years, 95%CI 0.8–14.6 years) and their cranial defect size tended to be wider than in patients without bone flap resorption (mean circumference 39 vs. 37 cm; MD 2.4 cm, 95% CI -0.43–5.2 cm) and follow-up duration was significantly longer (44 vs. 14 months, MD 29 months, 95%CI 17–42 months). Conclusion: A neoplasm as initial diagnosis, longer hospitalization after decompressive craniectomy, larger time interval between decompressive craniectomy and cranioplasty, and longer follow-up duration are associated with a higher risk of failure of autologous bone flaps for cranioplasty. Patients with these risk factors may be better served with an early recovery program after decompressive surgery or an alloplastic material for cranioplasty.",

author = "{van de Vijfeijken}, {S E.C.M.} and C. Groot and D.T. Ubbink and W.P. Vandertop and P.R.A.M. Depauw and E. Nout and A.G. Becking and {CranioSafe Group} and C.J. Kleverlaan and L. Dubois and L.H.E. Karssemakers and D.M.J. Milstein and F.W.A. Hoefnagels and T.J.A.G. M{\"u}nker and T.J.J. Maal and M. Riool and S.A.J. Zaat",

year = "2019",

month = sep,

doi = "10.1016/j.jcms.2019.02.007",

language = "English",

volume = "47",

pages = "1420--1425",

journal = "Journal of Cranio-Maxillofacial Surgery",

issn = "1010-5182",

publisher = "Churchill Livingstone",

number = "9",

}

TY - JOUR

T1 - Factors related to failure of autologous cranial reconstructions after decompressive craniectomy

AU - van de Vijfeijken, S E.C.M.

AU - Groot, C.

AU - Ubbink, D.T.

AU - Vandertop, W.P.

AU - Depauw, P.R.A.M.

AU - Nout, E.

AU - Becking, A.G.

AU - CranioSafe Group

AU - Kleverlaan, C.J.

AU - Dubois, L.

AU - Karssemakers, L.H.E.

AU - Milstein, D.M.J.

AU - Hoefnagels, F.W.A.

AU - Münker, T.J.A.G.

AU - Maal, T.J.J.

AU - Riool, M.

AU - Zaat, S.A.J.

PY - 2019/9

Y1 - 2019/9

N2 - Purpose: Cranioplasty is customary after decompressive craniectomy. Many different materials have been developed and used for this procedure. The ideal material does not yet exist, while complication rates in cranioplasties remain high. This study aimed to determine factors related to autologous bone flap failure. Materials and methods: In this two-center retrospective cohort study, 276 patients underwent autologous bone cranioplasty after initial decompressive craniectomy between 2004 and 2014. Medical records were reviewed regarding patient characteristics and factors potentially related to bone flap failure. Data were analyzed using univariable and multivariable regression analysis. Results: Independent factors related to overall bone flap failure were: duration of hospitalization after decompressive craniectomy [OR: 1.012 (95%CI: 1.003–1.022); p = 0.012], time interval between decompressive craniectomy and cranioplasty [OR: 1.018 (95%CI: 1.004–1.032); p = 0.013], and follow-up duration [OR: 1.034 (95%CI: 1.020–1.047); p < 0.001]. In patients with bone flap infection, neoplasm as initial diagnosis occurred significantly more often (29.2% vs. 7.8%; RD 21.3%; 95%CI 8.4 –38.3%; NNH 5; 95%CI 3 –12) and duration of hospitalization after decompressive craniectomy tended to be longer (means 54 vs. 28 days, MD 26.2 days, 95%CI −8.6 to 60.9 days). Patients with bone flap resorption were significantly younger (35 vs. 43 years, MD 7.7 years, 95%CI 0.8–14.6 years) and their cranial defect size tended to be wider than in patients without bone flap resorption (mean circumference 39 vs. 37 cm; MD 2.4 cm, 95% CI -0.43–5.2 cm) and follow-up duration was significantly longer (44 vs. 14 months, MD 29 months, 95%CI 17–42 months). Conclusion: A neoplasm as initial diagnosis, longer hospitalization after decompressive craniectomy, larger time interval between decompressive craniectomy and cranioplasty, and longer follow-up duration are associated with a higher risk of failure of autologous bone flaps for cranioplasty. Patients with these risk factors may be better served with an early recovery program after decompressive surgery or an alloplastic material for cranioplasty.

AB - Purpose: Cranioplasty is customary after decompressive craniectomy. Many different materials have been developed and used for this procedure. The ideal material does not yet exist, while complication rates in cranioplasties remain high. This study aimed to determine factors related to autologous bone flap failure. Materials and methods: In this two-center retrospective cohort study, 276 patients underwent autologous bone cranioplasty after initial decompressive craniectomy between 2004 and 2014. Medical records were reviewed regarding patient characteristics and factors potentially related to bone flap failure. Data were analyzed using univariable and multivariable regression analysis. Results: Independent factors related to overall bone flap failure were: duration of hospitalization after decompressive craniectomy [OR: 1.012 (95%CI: 1.003–1.022); p = 0.012], time interval between decompressive craniectomy and cranioplasty [OR: 1.018 (95%CI: 1.004–1.032); p = 0.013], and follow-up duration [OR: 1.034 (95%CI: 1.020–1.047); p < 0.001]. In patients with bone flap infection, neoplasm as initial diagnosis occurred significantly more often (29.2% vs. 7.8%; RD 21.3%; 95%CI 8.4 –38.3%; NNH 5; 95%CI 3 –12) and duration of hospitalization after decompressive craniectomy tended to be longer (means 54 vs. 28 days, MD 26.2 days, 95%CI −8.6 to 60.9 days). Patients with bone flap resorption were significantly younger (35 vs. 43 years, MD 7.7 years, 95%CI 0.8–14.6 years) and their cranial defect size tended to be wider than in patients without bone flap resorption (mean circumference 39 vs. 37 cm; MD 2.4 cm, 95% CI -0.43–5.2 cm) and follow-up duration was significantly longer (44 vs. 14 months, MD 29 months, 95%CI 17–42 months). Conclusion: A neoplasm as initial diagnosis, longer hospitalization after decompressive craniectomy, larger time interval between decompressive craniectomy and cranioplasty, and longer follow-up duration are associated with a higher risk of failure of autologous bone flaps for cranioplasty. Patients with these risk factors may be better served with an early recovery program after decompressive surgery or an alloplastic material for cranioplasty.

U2 - 10.1016/j.jcms.2019.02.007

DO - 10.1016/j.jcms.2019.02.007

M3 - Article

C2 - 31353299

SN - 1010-5182

VL - 47

SP - 1420

EP - 1425

JO - Journal of Cranio-Maxillofacial Surgery

JF - Journal of Cranio-Maxillofacial Surgery

IS - 9

ER -

Factors related to failure of autologous cranial reconstructions after decompressive craniectomy

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