Page 75 - Clinical relevance of current materials for cranial implants

Overall complication rate
Possible predictive parameters included in the regression model were: gender,
age at the time of cranioplasty, co-morbidities (diabetes mellitus, cardiovascular
disease, or both), initial indication for decompressive craniectomy (cerebrovascular,
trauma, neoplasm, infection), time interval between decompressive craniectomy
and cranioplasty, length of cranioplasty procedure (scored from scalp incision 3 to closure), duration of hospitalization after decompressive craniectomy and
cranioplasty, failure of cranioplasty, the year of the decompressive craniectomy and cranioplasty, and follow-up duration (calculated from the moment of replacement of the autologous bone flap until the last patient contact before December 2014). Significant independent predictive parameters were: duration of hospitalization after decompressive craniectomy [OR: 1.012 (95%CI: 1.003–1.022); p=0.012] (this OR means that each additional day of hospitalization leads to 1.2% more risk of flap failure); time interval between decompressive craniectomy and cranioplasty [OR: 1.018 (95%CI: 1.004–1.032); p=0.013] (each additional week between decompressive craniectomy and cranioplasty leads to 1.8% higher risk of flap failure); and follow-up duration [OR: 1.034 (95%CI: 1.020–1.047); p<0.001] (i.e., each additional month of follow-up leads to 3.4% higher risk of failure of the bone flap).
Infection
A neoplasm as initial diagnosis occurred more frequently in patients with infection (29.2% vs. 7.8%; RD 21.3%; 95%CI 8.4-38.3%; NNH 5; 95%CI 3-12). The duration of hospitalization after decompressive craniectomy tended to be longer in those with an infected bone flap (means 54 vs. 28 days, MD 26.2 days, 95%CI -8.6 to 60.9 days).
Resorption
Younger patients had a significantly higher risk of bone flap resorption (35 years in the resorption group vs. 43 years in those without resorption; MD 7.7 years, 95%CI 0.8- 14.6 years) as well as those with a longer follow-up duration (44 vs. 14 months, MD 29 months, 95%CI 17-42 months). A larger cranial defect size tended to have some influence (mean circumference 39 vs. 37cm; MD 2.4cm, 95% CI -0.43 to 5.2cm).
Autologous cranioplasty
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