Introduction: Decompressive craniectomy (DC) complications are known for traumatic brain injury (TBI) patients, but unclear for patients with other surgical indications. Our purpose was to study DC complications in a large series of patients with diverse surgical indications.
Methods: Single-institution retrospective review of prospectively collected data for all patients undergoing DC from 2003 to 2010. Parameters include patient demographics, clinical presentation, DC type, postoperative complications, cranioplasty type, and clinical outcome. Descriptive statistics and relational analyses are reported.
Results: 191 patients (52% female; mean age=50 years, range=17-85 years) underwent DC. Mean presenting Glasgow Coma Scale (GCS) score was 8, range=3-15. Common surgical indications were intracranial hemorrhage (n=70, 37%), aneurysm rupture (n=60, 31%), and cerebral edema secondary to prior elective surgery (n=21, 11%). 187 patients (98%) underwent unilateral DC and 4 (2%) had bilateral DC. 101 patients (53%) had at least 1 postoperative complication. Common complications were hydrocephalus (n=55, 28%), infection (n=42, 22%), and herniation (n=40, 21%). 90 patients (47%) underwent cranioplasty (autologous n=62, synthetic n=11) and 19 (10%) required repeat procedures secondary to flap infection. Mean duration from craniectomy to cranioplasty was 156 days, range=11-540 days. In comparison to historical controls, flap cryopreservation was associated with infection compared to subcutaneous pocket storage (OR=2.1, SD=1.0-4.4). Patients were discharged home (n=13, 7%), rehabilitation (n=121, 63%), full-time nursing facility (n=8, 4%), or hospice (n=1). 42 patients (22%) died during hospitalization. Complications were not associated with specific patient demographics or clinical presentations, but were inversely related to GCS score at discharge (Spearman's rho=-0.17, p=0.06), and patients with at least 1 postoperative complication had lower mean GCS score at discharge than those without (p=0.016).
Conclusions: Complications are common in DC patients, regardless of surgical indication. Flap cryopreservation was associated with infection compared to subcutaneous pocket storage. Effective strategies to reduce DC complications are warranted, as complications worsen clinical outcomes.
Patient Care: There are many papers that look at the complication rates for patients undergoing DC for traumatic brain injury. Our paper focuses on the complications that arise for patients undergoing DC for other surgical indications. This will provide a more complete picture of the complications that may arise with DC and allow physicians to come up with effective strategies to reduce DC complications to achieve better clinical outcomes.
Learning Objectives: By the conclusion of this session participants should be able to: (1) Describe common complications associated with decompressive craniectomy, and (2) Appreciate the relationship between different surgical indications and complication incidence.