Optimal timing for early cranioplasty following craniectomy: A propensity-matched national database study of 3241 patients

Introduction

Nearly 30 % of patients experience complications following cranioplasty after decompressive craniectomy. However, the optimal timing for this procedure is not well established.

Objective

To compare complication rates for cranioplasty performed at different early monthly intervals after craniectomy.

Methods

Using the TriNetX Research Network, we included patients who underwent either late cranioplasty (91 days-1 year), or cranioplasty in the first, second, or third month after craniectomy. Propensity score matching was used to match the late cranioplasty group separately with the other three cranioplasty groups based on baseline characteristics in the whole cohort and in a TBI-specific subgroup. Postoperative outcomes were assessed at 6 months after cranioplasty.

Results

We analyzed 3241 patients. After matching, 375 patients remained in the first-month, 365 in the second month, and 434 in the third-month group. Compared to late cranioplasty, ICH as a post-operative outcome was significantly more common in the first-month cranioplasty (p = 0.037) and second-month cranioplasty (p = 0.042) groups, while SDH as a post-operative outcome was more frequent in all early cranioplasty groups (p < 0.01). The need for repeat cranioplasty was higher in the first month (p = 0.002) and second month (p = 0.031) groups. Repeat Craniectomy/Craniotomy and CSF leak were more common in the first-month group (p = 0.006 and 0.001, respectively). Mortality was higher in the first month (RR=2.9, 95 %CI:1.5–5.5, p = 0.001) cranioplasty group.

Conclusion

Cranioplasty within 2 months after craniectomy was associated with increased postoperative morbidity and mortality, especially for patients without TBI. Prospective studies are needed to establish the best timing for cranioplasty.