Subgaleal drains may be associated with decreased infection following autologous cranioplasty: a retrospective analysis.

BACKGROUND Autologous bone is often the first choice in cranioplasty following a decompressive craniectomy. However, infection is a common complication, with reported rates up to 25%. While the incidence and management of infection are well documented, the risk factors associated with infection remain less clear. The current study aims to identify predictors of infection risk following autologous cranioplasty. METHODS A retrospective analysis was conducted on patients who underwent decompressive craniectomy and cranioplasty using cryopreserved autologous bone flaps between 2010 and 2020. Patient demographics and factors related to both surgeries and infection rates were recorded from patient records. Logistic regressions were conducted to determine which factors were implicated in the development of infection. RESULTS In our cohort, 126 patients underwent autologous cranioplasty. A total of 10 patients (7.9%) developed an infection following reconstruction, with half resulting in implant failure. We did not identify any significant risk factors for infection. Regression analysis identified placement of subgaleal drain following cranioplasty as a protective factor against the development of infection (OR: 0.16, p = 0.007). On average, drains remained in for 3 days, with no difference between the length of drains for those with infection vs. those without (p = 0.757). CONCLUSIONS The current study demonstrates an infection rate of 7.9% in patients who receive an autologous cranioplasty following decompressive craniectomy, which is consistent with previous data. Half (4%) of patients who experienced an infection ultimately required removal of the implant. While it is common practice for neurosurgeons to use drains to prevent hematomas and fluid collections, we found that subgaleal drain placement following cranioplasty was associated with decreased infection, thus demonstrating another benefit of a commonly used tool.

[1]  C. McMahon,et al.  Sudden death associated with the use of suction drains - a report of 2 cases following uneventful cranioplasty and literature review. Is the use of suction drains safe? , 2021, British journal of neurosurgery.

[2]  W. Vandertop,et al.  Factors related to failure of autologous cranial reconstructions after decompressive craniectomy. , 2019, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[3]  Wedad Almadani,et al.  Predictors of Surgical Site Infection in Cranioplasty: A Retrospective Analysis of Subcutaneously Preserved Bone Flaps in Abdominal Pockets. , 2019, World neurosurgery.

[4]  Soon-Young Hwang,et al.  Defining “early” cranioplasty to achieve lower complication rates of bone flap failure: resorption and infection , 2018, Acta Neurochirurgica.

[5]  W. Vandertop,et al.  Autologous Bone Is Inferior to Alloplastic Cranioplasties: Safety of Autograft and Allograft Materials for Cranioplasties, a Systematic Review. , 2018, World neurosurgery.

[6]  Jason W. Allen,et al.  Autologous Cranioplasty is Associated with Increased Reoperation Rate: A Systematic Review and Meta-Analysis. , 2018, World neurosurgery.

[7]  M. Scerrati,et al.  Decompressive Craniectomy for Traumatic Brain Injury: The Role of Cranioplasty and Hydrocephalus on Outcome. , 2018, World neurosurgery.

[8]  J. Grossberg,et al.  Early Cranioplasty is Associated with Greater Neurological Improvement: A Systematic Review and Meta-Analysis , 2018, Neurosurgery.

[9]  Wenshuai Deng,et al.  Cryopreservation of Autologous Cranial Bone Flaps for Cranioplasty: A Large Sample Retrospective Study. , 2018, World neurosurgery.

[10]  J. Grossberg,et al.  Complications following cranioplasty and relationship to timing: A systematic review and meta-analysis , 2016, Journal of Clinical Neuroscience.

[11]  G. Tipper,et al.  Cranioplasty outcomes and associated complications: A single-centre observational study , 2016, British journal of neurosurgery.

[12]  J. Simard,et al.  Complications Associated with Decompressive Craniectomy: A Systematic Review , 2015, Neurocritical Care.

[13]  J. White,et al.  Autologous and acrylic cranioplasty: a review of 10 years and 258 cases. , 2014, World neurosurgery.

[14]  B. Schoekler,et al.  Prediction parameters of bone flap resorption following cranioplasty with autologous bone , 2014, Clinical Neurology and Neurosurgery.

[15]  E. Ronne-Engström,et al.  Surgical site infections in standard neurosurgery procedures– a study of incidence, impact and potential risk factors , 2014, British journal of neurosurgery.

[16]  E. Broughton,et al.  Seven years of cranioplasty in a regional neurosurgical centre , 2014, British journal of neurosurgery.

[17]  W. Sorteberg,et al.  Cranioplasty with autologous cryopreserved bone after decompressive craniectomy. Complications and risk factors for developing surgical site infection , 2014, Acta Neurochirurgica.

[18]  K. Jo,et al.  Analysis of the factors affecting graft infection after cranioplasty , 2013, Acta Neurochirurgica.

[19]  L. Koskinen,et al.  Complications following cranioplasty using autologous bone or polymethylmethacrylate—Retrospective experience from a single center , 2013, Clinical Neurology and Neurosurgery.

[20]  Young Sup Park,et al.  Long-Term Incidence and Predicting Factors of Cranioplasty Infection after Decompressive Craniectomy , 2012, Journal of Korean Neurosurgical Society.

[21]  C Schaller,et al.  Cranioplasty for large skull defects with PMMA (Polymethylmethacrylate) or Tutoplast processed autogenic bone grafts. , 2007, Zentralblatt fur Neurochirurgie.

[22]  G. Rath,et al.  Bradycardia following negative pressure suction of subgaleal drain during craniotomy closure , 2007, Acta Neurochirurgica.

[23]  M Galarza,et al.  Continuous subgaleal suction drainage for the treatment of chronic subdural haematoma , 2007, Acta Neurochirurgica.

[24]  K. Karamchandani,et al.  Severe bradycardia and hypotension after connecting negative pressure to the subgaleal drain during craniotomy closure. , 2006, British journal of anaesthesia.

[25]  K. Mukherjee,et al.  Subgaleal suction drain leading to fatal sagittal sinus haemorrhage , 2005, British journal of neurosurgery.

[26]  Eeh Hussein Mohamed.  Chronic subdural haematoma treated by craniotomy, durectomy, outer membranectomy and subgaleal suction drainage. Personal experience in 39 patients , 2003, British journal of neurosurgery.

[27]  E. Connolly,et al.  Ventriculostomy-related Infections: A Critical Review of the Literature , 2002, Neurosurgery.

[28]  L. Malis,et al.  Subgaleal shunting: a 20-year experience. , 2000, Neurosurgical focus.

[29]  Jack C. Yu,et al.  Infections in Craniofacial Surgery: A Combined Report of 567 Procedures from Two Centers , 1997, Plastic and reconstructive surgery.

[30]  K. Tokoro,et al.  Late infection after cranioplasty--review of 14 cases. , 1989, Neurologia medico-chirurgica.

[31]  L. Oliver.  Intracranial Suppuration , 1933, Postgraduate medical journal.