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

Objectives: To compare postoperative outcomes after cranioplasties performed by neurosurgery only (N) versus neurosurgery and plastic surgery combined (N+P).

Methods: A single-center, multisurgeon, retrospective cohort study was undertaken on all cranioplasties performed from November 2006 to December 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.

Results: Of 188 patients undergoing cranioplasty during the study period, 106 (56%) patients were in the N group, and 82 (44%) were in the N+P group. Patient demographics were similar between the 2 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 2 groups. Furthermore, the N group had less Jackson-Pratt drain use (58.5% vs. 85.4%, P < 0.001), earlier drain removal (1.9 ± 1.6 vs. 3.4 ± 3.9 days, P < 0.001), and shorter LOS (3.8 ± 5.9 vs. 4.7 ± 3.9 days, P < 0.001). On multivariate regression analysis controlling for age, body mass index, smoking, craniectomy type, reason for craniectomy, and graft type, N+P was associated with increased drain use (odds ratio = 4.90, 95% confidence interval 2.28-11.30, P < 0.001) and longer drain duration (β = 1.50, 95% confidence interval 0.43-2.60, P = 0.007).

Conclusions: Despite similar complication and reoperation rates between groups, reoperations in the N group occurred sooner, whereas the N+P group more commonly used drains and kept drains in for longer.