Comparison between subcutaneous pocket and cryopreservation method for storing autologous bone flaps in developing bone flap infection after cranioplasty, a prospective observational multi-center study of 100 cases

2020 ◽  
Author(s):  
Mehdi Shafiei ◽  
Arman Sourani ◽  
Amir Arsalan Korki ◽  
Saeed Mahram
Keyword(s):  
Risk Factors ◽  
Infection Rate ◽  
Bone Flap ◽  
Bone Banking ◽  
Statistical Measures ◽  
Autologous Bone ◽  
Multi Center Study ◽  
Associated Risk Factors ◽  
Cryopreservation Method ◽  
Center Study

Abstract Background Following a craniotomy, harvested bone flap, if available, is stored for future cranioplasty. There are two different methods for bone banking: subcutaneous pocket in abdominal wall and cryopreservation in a refrigerator. This study is designed to evaluate risk of developing infection in each group, retrospectively. Methods In this prospective observational multi-center study, one hundred (100) patients who underwent cranioplasty with autologous bone flap were divided into two groups of 50 patients. rate of clinical post-operative infection and possible associated risk factors were analyzed with statistical measures. The data check lists parameters were indication of DC, CP vs SP, interval between craniotomy and cranioplasty, post-operative hospitalization duration, new morbidities and possible mortalities. The data were analyzed by an expert bio-statistician with proper bio-statistical methods (p<0.05) Results Four (4) patient in cryopreservation group (50 patients) had post-operative bone flap infection (8%).in subcutaneous pocket method no post-operative infection after cranioplasty was noticed, which are not statistically significant (p=0.054). over-all post-operative infection rate was 4%. Conclusion There were no significant differences in post-operative infection rate between cryopreservation versus subcutaneous pocket method in storing bone flaps. Older age maybe associated with infection development after cranioplasty.

scholarly journals Subcutaneous bone flap storage after emergency craniectomy: cost-effectiveness and rate of resorption

2018 ◽  
Vol 129 (6) ◽  
pp. 1604-1610 ◽  
Author(s):  
Griffin Ernst ◽  
Fares Qeadan ◽  
Andrew P. Carlson
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Bone Resorption ◽  
Decompressive Craniectomy ◽  
Significant Risk ◽  
Bone Flap ◽  
Type I ◽  
Custom Implant ◽  
Autologous Bone ◽  
Clinically Significant

OBJECTIVEDecompressive craniectomy is used for uncontrolled intracranial pressure in traumatic brain injury and malignant hemispheric stroke. Subcutaneous preservation of the autologous bone flap in the abdomen is a simple, portable technique but has largely been abandoned due to perceived concerns of resorption. The authors sought to characterize their experience with subcutaneous preservation of the bone flap and cranioplasty.METHODSThe authors performed a retrospective single-institution review of subcutaneous preservation of the autologous bone flap after decompressive craniectomy from 2005 to 2015. The primary outcome was clinically significant bone resorption, defined as requiring a complete mesh implant at the time of cranioplasty, or delayed revision. The outcome also combined cases with any minor bone resorption to determine predictors of this outcome. Logistic regression modeling was used to determine the risk factors for predicting resorption. A cost comparison analysis was also used via the 2-sided t-test to compare the cost of cranioplasty using an autologous bone flap with standard custom implant costs.RESULTSA total of 193 patients with craniectomy were identified, 108 of whom received a cranioplasty. The mean time to cranioplasty was 104.31 days. Severe resorption occurred in 10 cases (9.26%): 4 were clinically significant (2 early and 2 late) and 6 demonstrated type II (severe) necrosis on CT, but did not require revision. Early resorption of any kind (mild or severe) occurred in 28 (25.93%) of 108 cases. Of the 108 patients, 26 (24.07%) required supplemental cranioplasty material. Late resorption of any kind (mild or severe) occurred in 6 (5.88%) of 102 cases. Of these, a clinically noticeable but nonoperative deformity was noted in 4 (3.92%) and minor (type I) necrosis on CT in 37 (37%) of 100. Bivariate analysis identified fragmentation of bone (OR 3.90, 95% CI 1.03–14.8), shunt-dependent hydrocephalus (OR 7.97, 95% CI 1.57–40.46), and presence of post-cranioplasty drain (OR 9.39, 95% CI 1.14–1000) to be significant risk factors for bone resorption. A binary logistic regression optimized using Fisher’s scoring determined the optimal multivariable combination of factors. Fragmentation of bone (OR 5.84, 95% CI 1.38–28.78), diabetes (OR 7.61, 95% CI 1.37–44.56), and shunt-dependent hydrocephalus (OR 9.35, 95% CI 1.64–56.21) were found to be most predictive of resorption, with a C value of 0.78. Infections occurred in the subcutaneous pocket in 5 (2.60%) of the 193 cases and after cranioplasty in 10 (9.26%) of the 108 who underwent cranioplasty. The average cost of cranioplasty with autologous bone was $2156.28 ± $1144.60 (n = 15), and of a custom implant was $35,118.60 ± $2067.51 (3 different sizes; p < 0.0001).CONCLUSIONSCraniectomy with autologous bone cranioplasty using subcutaneous pocket storage is safe and compares favorably to cryopreservation in terms of resorption and favorably to a custom synthetic implant in terms of cost. While randomized data are required to definitively prove the superiority of one method, subcutaneous preservation has enough practical advantages with low risk to warrant routine use for most patients.

Multi-Center Study Regarding the Risk Factors for Bleeding in Gastrointestinal Stromal Tumor

2012 ◽  
Author(s):  
Kyung Sik Park ◽  
Kyu Chan Huh ◽  
Ilseon Hwang ◽  
Jung Hyeok Kwon ◽  
Joong Goo Kwon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastrointestinal Stromal Tumor ◽  
Stromal Tumor ◽  
Multi Center Study ◽  
Center Study

scholarly journals Epidemiological and Clinical Risk Factors Related to Severe COVID-19 in Iran: A multi-center study

2020 ◽  
Author(s):  
Seyed Mohammad Hashemi-Shahri ◽  
Seyed Mohammad Nasiraldin Tabatabaei ◽  
Alireza Ansari-moghaddam ◽  
Mahdi Mohammadi ◽  
Hassan Okati-Aliabad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Substance Abuse ◽  
Disease Severity ◽  
Underlying Disease ◽  
Severe Condition ◽  
Factors Affecting ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Multi Center Study ◽  
Center Study

Abstract Background Iran was one of the first countries to be affected by COVID-19. Identifying factors associated with severity of COVID-19 is effective in disease management. This study investigated the epidemiological and clinical features and factors associated with severity of COVID-19 in one of the less privileged areas in Iran.Methods In a multi-center study, all patients admitted to hospitals of Zahedan University of Medical Sciences located in southeastern Iran were investigated from February 29 to April 31, 2020. Demographic, epidemiological and clinical data of patients were extracted from medical records. To explore the risk factors associated with severity of COVID-19, bivariate and multivariate logistic regression models were used.Results Among the 413 patients, 55.5% were male and 145 (35.10%) were in a severe condition at admission time. Multivariate analysis showed that the adjusted odds of the disease severity increased in patients with older age (OR 3.51; 95% CI, 2.28-5.40), substance abuse (OR 2.22; 95% CI, 2.05-5.78) and at least one underlying disease (OR 3.45; 95% CI, 1.01-1.32).Conclusions COVID-19 was more severe in older patients, patients with a history of substance abuse, and patients with at least one underlying disease. Understanding the factors affecting the disease severity can help for clinical management of COVID-19, especially in less privileged areas where fewer resources are available.

scholarly journals A multi-center study on the risk factors of infection caused by multi-drug resistant Acinetobacter baumannii

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Huiping Huang ◽  
Borong Chen ◽  
Gang Liu ◽  
Jing Ran ◽  
Xianyu Lian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acinetobacter Baumannii ◽  
Drug Resistant ◽  
Multi Center Study ◽  
Center Study
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