Outcomes of cranioplasty following decompressive craniectomy in the pediatric population

2013 ◽  
Vol 12 (2) ◽  
pp. 120-125 ◽  
Author(s):  
Brandon G. Rocque ◽  
Kaushik Amancherla ◽  
Sean M. Lew ◽  
Sandi Lam
Keyword(s):  
Bone Resorption ◽  
Decompressive Craniectomy ◽  
Complication Rate ◽  
Case Reports ◽  
Pediatric Population ◽  
Defect Size ◽  
Complication Rates ◽  
Appreciable Effect ◽  
Pooled Data ◽  
Early Cranioplasty

Cranioplasty is routinely performed following decompressive craniectomy in both adult and pediatric populations. In adults, this procedure is associated with higher rates of complications than is elective cranial surgery. This study is a review of the literature describing risk factors for complications after cranioplasty surgery in pediatric patients. A systematic search of PubMed, Cochrane, and SCOPUS databases was undertaken. Articles were selected based on their titles and abstracts. Only studies that focused on a pediatric population were included; case reports were excluded. Studies in which the authors assessed bone flap storage method, timing of cranioplasty, material used (synthetic vs autogenous), skull defect size, and/or complication rates (bone resorption and surgical site infection) were selected for further analysis. Eleven studies that included a total of 441 cranioplasties performed in the pediatric population are included in this review. The findings are as follows: 1) Based on analysis of pooled data, using cryopreserved bone flaps during cranioplasty may lead to a higher rate of bone resorption and lower rate of infection than using bone flaps stored at room temperature. 2) In 3 of 4 articles describing the effect of time between craniectomy and cranioplasty on complication rate, the authors found no significant effect, while in 1 the authors found that the incidence of bone resorption was significantly lower in children who had undergone early cranioplasty. Pooling of data was not possible for this analysis. 3) There are insufficient data to assess the effect of cranioplasty material on complication rate when considering only cranioplasties performed to repair decompressive craniectomy defects. However, when considering cranioplasties performed for any indication, those in which freshly harvested autograft is used may have a lower rate of resorption than those in which stored autograft is used. 4) There is no appreciable effect of craniectomy defect size or patient age on complication rate. There is a paucity of articles describing outcomes and complications following cranioplasty in children and adolescents. However, based on the studies examined in this systematic review, there are reasons to suspect that method of flap preservation, timing of surgery, and material used may be significant. Larger prospective and retrospective studies are needed to shed more light on this important issue.

scholarly journals Cranioplasty following decompressive craniectomy – Analysis of complication rates and neurological outcomes: A single center study

2019 ◽  
Vol 10 ◽  
pp. 142 ◽  
Author(s):  
Saraj Singh ◽  
Rakesh Singh ◽  
Kapil Jain ◽  
Bipin Walia
Keyword(s):  
Decompressive Craniectomy ◽  
Complication Rate ◽  
Neurological Outcome ◽  
Simple Procedure ◽  
Surgical Techniques ◽  
Bone Flap ◽  
Intracerebral Hematoma ◽  
Complication Rates ◽  
Good Neurological Outcome ◽  
Second Surgery

Background:Cranioplasty is the surgical intervention to repair cranial defects in both cosmetic and functional ways. Despite the fact that cranioplasty is a simple procedure, it is still associated with a relatively high complication rate, ranging between series from 12% to 50%.Methods:The author did a prospective cohort study of patients from August 2015 to December 2017, who had undergone decompressive craniectomy followed by cranioplasty after 6 weeks at our institution. All patients were followed up to 6 months after cranioplasty and complications were recorded both by imaging and clinically. The complications were classified as minor (subgaleal collection, seizures) who did not require the second surgery and major (hydrocephalus, bone flap infection) who required the second surgery. To find out neurological outcome, Glasgow coma score (GCS) and Glasgow outcome scale extended (GOSE) were recorded at 1 month, 3 months, and 6 months.Results:Overall complication rate in this study was 22.4% (16/72). Subgaleal collection was the most common complication (5.6%), followed by hydrocephalus (4.2%), seizure (4.2%), bone flap infection (2.8%), intracerebral hematoma (2.8%), empyema (1.4%), and subdural hematoma (SDH) (1.4%). Of these, 8.4% (n= 6/72) were major complication (hydrocephalusn= 3, bone flap infectionn= 2, and SDHn= 1) which required the second surgery. GCS and GOSE were assessed preoperatively and in postoperative period at 1 month, 3 months, and 6 months. Both mean values of GCS and GOSE showed a significant improvement at 3 and 6 months after cranioplasty.Conclusion:Cranioplasty after decompressive craniectomy is associated with higher complication rate, but good neurological outcome after surgery always outweighs the complications.Key Message:Cranioplasty after decompressive craniectomy is associated with higher complication rate, but good neurological outcome after surgery always outweighs the complications. However, complications rate can be brought down by meticulous timing of cranioplasty in a patient of well-controlled comorbidities and precise surgical techniques. However, storing bone in bone bank is not an additional factor for any postcranioplasty complications which was considered previously.

Evaluation of simultaneous cranioplasty and ventriculoperitoneal shunt procedures

2014 ◽  
Vol 121 (2) ◽  
pp. 313-318 ◽  
Author(s):  
Juneyoung Heo ◽  
Sukh Que Park ◽  
Sung Jin Cho ◽  
Jae Chil Chang ◽  
Hyung-ki Park
Keyword(s):  
Decompressive Craniectomy ◽  
Fluid Collection ◽  
Patient Characteristics ◽  
Defect Size ◽  
Complication Rates ◽  
Subdural Fluid Collection ◽  
Brain Swelling ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Cranial Defect

Object Some patients with severe brain swelling treated with decompressive craniectomy may develop hydrocephalus. Consequently, these patients require cranioplasty and a ventriculoperitoneal (VP) shunt to relieve the hydrocephalus. However, there is no consensus as to the timing of the cranioplasty and VP shunt placement in patients requiring both. The authors assessed the results of performing cranioplasty and VP shunt placement at the same time in patients with cranial defects and hydrocephalus. Methods A retrospective review was performed of 51 patients who had undergone cranioplasty and VP shunt operations after decompressive craniectomy for refractory intracranial hypertension between 2003 and 2012 at the authors' institution. Patient characteristics, data on whether the operations were performed simultaneously, brain bulging, hydrocephalus, cranial defect size, and complications were analyzed. Results The overall complication rate was 43% (22 of 51 patients). In 32 cases, cranioplasty and VP shunt placement were performed at the same time. Complications included subdural hematoma, subdural fluid collection, and infection. The group undergoing cranioplasty and VP shunt placement at the same time had higher complication rates than the group undergoing the procedures at different times (56% vs 21%, respectively). The severity of complications was also greater in the former group. Patients with severe brain bulging had higher complication rates than did those without brain bulging (51% vs 0%, respectively). Cranial defect size, severity of hydrocephalus, indication for decompressive craniectomy, age, sex, and interval between decompressive craniectomy and subsequent operation did not affect complication rates. Conclusions Patients undergoing cranioplasty and VP shunt placement at the same time had higher complication rates, especially those with severe brain bulging.

Timing of cranioplasty after decompressive craniectomy for ischemic or hemorrhagic stroke

2013 ◽  
Vol 118 (1) ◽  
pp. 109-114 ◽  
Author(s):  
Mark P. Piedra ◽  
Brian T. Ragel ◽  
Aclan Dogan ◽  
Nicholas D. Coppa ◽  
Johnny B. Delashaw
Keyword(s):  
Decompressive Craniectomy ◽  
Hemorrhagic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
Case Series ◽  
Csf Shunt ◽  
Optimal Timing ◽  
Complication Rates ◽  
Postoperative Hematoma ◽  
The Difference ◽  
Early Cranioplasty

Object The optimal timing of cranioplasty after decompressive craniectomy for stroke is not known. Case series suggest that early cranioplasty is associated with higher rates of infection while delaying cranioplasty may be associated with higher rates of bone resorption. The authors examined whether the timing of cranioplasty after decompressive craniectomy for stroke affects postoperative complication rates. Methods A retrospective cohort study was undertaken to evaluate complication rates in patients undergoing cranioplasty at early (within 10 weeks of craniectomy) or late (≥ 10 weeks) stages. Multivariate logistic regression analysis was used to determine characteristics that would predict complications in patients undergoing cranioplasty after decompressive craniectomy for stroke. Results While the overall complication rate was higher in the early cranioplasty cohort (22% vs 16% in the late cranioplasty cohort), the difference was not statistically significant (p = 0.5541). Patients in the early cranioplasty cohort had lower rates of postoperative hematoma but higher rates of infection. Presence of a CSF shunt was the only significant predictor of complications (OR 8.96, 95% CI 1.84–43.6). Conclusions Complications rates for early cranioplasty (within 10 weeks of craniectomy) are similar to those encountered when cranioplasty is delayed, although the cohort size in this study was too small to state equivalence. Patients with a ventriculoperitoneal shunt are at higher risk for complications after cranioplasty.

Optimal timing of autologous cranioplasty after decompressive craniectomy in children

2012 ◽  
Vol 10 (4) ◽  
pp. 268-272 ◽  
Author(s):  
Mark P. Piedra ◽  
Eric M. Thompson ◽  
Nathan R. Selden ◽  
Brian T. Ragel ◽  
Daniel J. Guillaume
Keyword(s):  
Intracranial Pressure ◽  
Bone Resorption ◽  
Decompressive Craniectomy ◽  
Pediatric Patients ◽  
Optimal Timing ◽  
Raised Intracranial Pressure ◽  
Elevated Intracranial Pressure ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Early Cranioplasty

Object The object of this study was to determine if early cranioplasty after decompressive craniectomy for elevated intracranial pressure in children reduces complications. Methods Sixty-one consecutive cases involving pediatric patients who underwent autologous cranioplasty after decompressive craniectomy for raised intracranial pressure at a single academic children's hospital over 15 years were studied retrospectively. Results Sixty-one patients were divided into early (< 6 weeks; 28 patients) and late (≥ 6 weeks; 33 patients) cranioplasty cohorts. The cohorts were similar except for slightly lower age in the early (8.03 years) than the late (10.8 years) cranioplasty cohort (p < 0.05). Bone resorption after cranioplasty was significantly more common in the late (42%) than the early (14%) cranioplasty cohort (p < 0.05; OR 5.4). No other complication differed in incidence between the cohorts. Conclusions After decompressive craniectomy for raised intracranial pressure in children, early (< 6 weeks) cranioplasty reduces the occurrence of reoperation for bone resorption, without altering the incidence of other complications.

Complication Rate after Radical Cystectomy Depends on the Surgical Technique and Patient’s Clinical Status

2021 ◽  
pp. 1-8
Author(s):  
Przemysław Adamczyk ◽  
Paweł Pobłocki ◽  
Mateusz Kadlubowski ◽  
Adam Ostrowski ◽  
Witold Mikołajczak ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Complication Rate ◽  
Tnm Stage ◽  
Complication Rates ◽  
Open Approach ◽  
Invasive Approach ◽  
Asa Score

<b><i>Purpose:</i></b> This study aimed to explore the complication rates of radical cystectomy in patients with muscle-invasive bladder cancer and identify potential risk factors. <b><i>Methods:</i></b> A total of 553 patients were included: 131 were operated on via an open approach (ORC), 242 patients via a laparoscopic method (LRC), and 180 by a robot-assisted procedure (RARC). Patient age, gender, American Society of Anesthesiologists (ASA) score, urinary diversion type, preoperative albumin level, body mass index (BMI), pathological (TNM) stage, and surgical times were collected. The severity of complications was classified according to the Clavien-Dindo scale (Grades 1–5). <b><i>Results:</i></b> The surgical technique was significantly related to the number of complications (<i>p</i> &#x3c; 0.00005). Grade 1 complications were observed most frequently following LRC (52.5%) and RARC (51.1%), whereas mostly Grade 2 complications were detected after ORC (78.6%). Those with less severe complications had significantly higher albumin levels than those with more severe complications (<i>p</i> &#x3c; 0.05). Patients with an elevated BMI had fewer complications if a minimally invasive approach was used rather than ORC. The patient’s general condition (ASA score) did not impact the number of complications, and urinary diversion type did not affect the severity of the complications. Mean surgical time differed according to the urinary diversion type in patients with a similar TNM stage (<i>p</i> &#x3c; 0.005); however, no difference was found in those with more locally advanced disease. Longer operation time and lower protein concentration were associated with higher probability of complication rate, that is, Clavien-Dindo score 3–5. <b><i>Conclusions:</i></b> The risk of complications after RC is not related to the type of urinary diversion, and can be reduced by using a minimally invasive surgical technique, especially in patients with high BMI.

Complications following local anaesthetic transperineal prostate biopsies without antibiotic prophylaxis: An institution’s experience

2021 ◽  
pp. 205141582098766
Author(s):  
Joseph B John ◽  
Angus MacCormick ◽  
Ruaraidh MacDonagh ◽  
Mark J Speakman ◽  
Ramesh Vennam ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Local Anaesthetic ◽  
Complication Rate ◽  
Admission Rate ◽  
Prophylactic Antibiotics ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Hospital Admission Rate ◽  
Prostate Biopsies ◽  
Disease Characteristics

Objectives: This study aimed to describe a UK institution’s experience with local anaesthetic (LA) transperineal (TP) prostate biopsies (PB), and to report 30-day complications following LATPPB, including a large cohort that did not receive antibiotic prophylaxis. Patients and methods: A prospective database of 313 consecutive patients undergoing LATPPB was maintained, describing patient and disease characteristics, and complications. From September 2019 to January 2020, antibiotic prophylaxis was given before LATPPB ( n=149). Following a change to routine care, from January 2020 to July 2020, prophylactic antibiotics were not given before LATPPB ( n=164). A comparative analysis was performed to determine complication rates following antibiotic prophylaxis discontinuation using electronic hospital and primary care records. Results: Patient and disease characteristics were comparable in antibiotic and non-antibiotic cohorts, and representative of PB and prostate cancer cohorts described in the urological literature. The infection-related complication rate was 0.32% across all patients, and 0% for those not receiving antibiotic prophylaxis. The overall complication rate was 0.64%, and 0.61% for those not receiving antibiotic prophylaxis. There were no severe (Clavien–Dindo 3–5) complications. The unplanned hospital admission rate was 0.64%. Conclusion: The complication rate after LATPPB was low, with no infection-related complications in patients who did not receive antibiotic prophylaxis. This provides further evidence supporting the discontinuation of routine prophylactic antibiotics before TPPB. Level of evidence: Level 2b.

Surgeon Volume and Complications in Lateral Neck Dissection for Squamous Cell Carcinoma: A Multidatabase Analysis

2021 ◽  
pp. 019459982110004
Author(s):  
James C. Campbell ◽  
Hui-Jie Lee ◽  
Trinitia Cannon ◽  
Russel R. Kahmke ◽  
Walter T. Lee ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Neck Dissection ◽  
Squamous Cell ◽  
Complication Rate ◽  
Surgeon Volume ◽  
Complication Rates ◽  
Lateral Neck ◽  
National Inpatient Sample ◽  
Unit Increase

Objective To determine whether annual surgeon volume of lateral neck dissections for squamous cell carcinoma is associated with complication rates. Study Design Retrospective review. Setting Two US databases spanning 2000 to 2014. Methods Neck dissections for squamous cell carcinoma from the National Inpatient Sample and State Inpatient Databases were analyzed. The primary outcome was any in-hospital complication common to neck dissection. The principal independent variable was surgeon volume. A multivariable logistic generalized estimating equation with a piecewise linear spline for surgeon volume was fit to assess its association with complication. Results The National Inpatient Sample had 3517 discharges fitting criteria, a median surgeon volume of 12, and an 11.1% complication rate. A 1-unit increase in surgeon volume was associated with a 7% increase in the odds of complication when volume ranged between 4 and 19 (adjusted odds ratio [AOR], 1.07; 95% CI, 1.04-1.11) and with a 3% decrease in the odds of complication when volume ranged between 19 and 51 (AOR, 0.97; 95% CI, 0.96-0.99). The State Inpatient Databases had 2876 discharges fitting criteria, a median surgeon volume of 30, and a 13.5% complication rate. Surgeon volume was not associated with complication when <27 (AOR, 1.01; 95% CI, 0.99-1.02), but a 5-unit increase in volume was associated with a 7% decrease in the odds of complication with volume ≥27 (AOR, 0.93; 95% CI, 0.88-0.98). Conclusions Surgeon volume was associated with complications for most volume ranges and with lower odds of complication for high-volume surgeons.

#49: Results of 10 Years of Peripherally Inserted Central Catheter Use and the Association with Infections in Pediatric Patients at a Tertiary Care Oncology Hospital

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S16-S16
Author(s):  
Jennia J Acebo ◽  
María Costta ◽  
Gisella Sánchez ◽  
Erika Villanueva ◽  
Erika Montalvo E ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Complication Rate ◽  
Best Practice ◽  
Infectious Complication ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Complication Rates ◽  
Peripheral Venous Access ◽  
Pediatric Cancer Patients

Abstract Introduction Pediatric cancer patients merit the placement of central lines for the treatments they receive. Subcutaneous central ports (SCs) and peripherally inserted central catheters (PICCs) are the most frequently used lines. PICCs have gained popularity due to the ease of insertion, which can be invaluable in the pediatric oncology setting for administration of intravenous therapy, parenteral nutrition, and/or blood products. Since central-line-associated bloodstream infections increase the morbidity and mortality of cancer patients, as well as increase the cost generated by their treatment, active surveillance of these healthcare-associated infections is warranted. Methods This is a retrospective descriptive study of pediatric patients treated via PICCs at the Hospital SOLCA Núcleo Quito between 2009 and 2019. Results During the study period, 70 PICC lines were placed in 66 patients, totaling 1862 catheter-days. The majority of patients (75.7%) were diagnosed with leukemia or lymphoma. As of 2011, all PICCs were placed in the operating room by a surgeon. Ultrasound was used 39 times for the insertion of PICCs. Inadequate peripheral venous access was the most common indication (64.2%) for placement. Twenty-nine PICCs had complications, of which 13 were infectious complications and 16 were noninfectious. The most common infectious complication was PICC-related bloodstream infection (13), and the most frequent noninfectious complication was occlusion (10). The overall complication rate was 15.5 complications per 1000 catheter-days, and the overall infectious complication rate was 6.9 complications per 1000 catheter days. Annual complication rates fluctuated over the study period. The PICC line-associated infection rate per 1000 catheter-days was 13.1‰ in 2009, 12.4‰ in 2010, 5.0‰ in 2011, 7.9‰ in 2012, 0 in 2013, 13.4‰ in 2014, 4.8‰ in 2015, 16.2‰ in 2016, 8.2‰ in 2017, and 4.3‰ in 2018. Conclusion In general, complications related to PICC in pediatric patients at a tertiary care oncology hospital have fluctuated over the years. Our findings indicate the need for further efforts in staff education and training in the insertion, care, and maintenance of PICC lines. Best practice guidelines are also critical to reducing complications, especially occlusion and infection rates, to thereby improve patient outcomes.

scholarly journals Admission and Acute Complication Rate for Outpatient Lumbar Microdiscectomy

2010 ◽  
Vol 37 (1) ◽  
pp. 49-53 ◽  
Author(s):  
Aria Fallah ◽  
Eric M. Massicotte ◽  
Michael G. Fehlings ◽  
Stephen J. Lewis ◽  
Yoga Raja Rampersaud ◽  
...  
Keyword(s):  
Complication Rate ◽  
Admission Rate ◽  
Complication Rates ◽  
Chi Square ◽  
Lumbar Microdiscectomy ◽  
Acute Complication ◽  
Admission Data ◽  
Improved Outcomes ◽  
Significant Difference ◽  
Revision Operations

Objective:Specialization is generally independently associated with improved outcomes for most types of surgery. This is the first study comparing the immediate success of outpatient lumbar microdiscectomy with respect to acute complication and conversion to inpatient rate. Long term pain relief is not examined in this study.Methods:Two separate prospective databases (one belonging to a neurosurgeon and brain tumor specialist, not specializing in spine (NS) and one belonging to four spine surgeons (SS)) were retrospectively reviewed. All acute complications as well as admission data of patients scheduled for outpatient lumbar microdiscectomy were extracted.Results:In total, 269 patients were in the NS group and 137 patients were in the SS group. The NS group averaged 24 cases per year while the SS group averaged 50 cases per year. Chi-square tests revealed no difference in acute complication rate [NS(6.7%), SS(7.3%)] (p>0.5) and admission rate [NS(4.1%), SS(5.8%)] (p=0.4) while the SS group had a significantly higher proportion of patients undergoing repeat microdiscectomy [NS(4.1%), SS(37.2%)] (p<0.0001). Excluding revision operations, there was no statistically significant difference in acute complication [NS(5.4%), SS(1.2%)] (p=0.09) and conversion to inpatient [NS(4.3%), SS(4.6%)] (p>0.5) rate. The combined acute complication and conversion to inpatient rate was 6.9% and 4.7% respectively.Conclusion:Based on this limited study, outpatient lumbar microdiscectomy can be apparently performed safely with similar immediate complication rates by both non-spine specialized neurosurgeons and spine surgeons, even though the trend favored the latter group for both outcome measures.

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