Introduction: Cranial reconstruction with cranioplasty is commonly performed. Current studies on cranioplasty outcomes are mostly limited to small, single-institution analyses. We sought to characterize cranioplasty outcomes at a population level using a longitudinal national claims database.
Methods: We identified patients who underwent cranioplasty between 2010 and 2012 in the MarketScan national database by Current Procedural Terminology coding. We analyzed the impact of age, autograft usage, and cranioplasty size on postoperative complications, mortality, and 30-day readmission rates. We further characterized the cost of care associated with cranioplasty.
Results: We identified 2,447 cranioplasty patients (mean age 43.6 ± 20.4 years, 47.7% male) consisting of 14.5% (N=355) children under 18 years, 74.9% (N=1,832) nonelderly adults between 18 and 64 years, and 10.6% (N=260) elderly adults age 65 years and over. The top indications for cranioplasty varied among the three age groups. We found an overall complication rate of 37.2%, mortality rate of 0.5%, and a 30-day readmission rate of 13.0%. Compared to pediatric and nonelderly adult patients, elderly adult patients showed a significantly higher rate of overall complications and mortality risk (p<0.0001 and p=0.0001, respectively). We found that large cranioplasties (greater than 5 cm) conferred a higher risk of overall complications than small cranioplasties (up to 5 cm, p=0.04). Cranioplasty size had no effect on mortality risk or 30-day readmissions. Regarding infection risk, only cranioplasty size influenced the rate of postoperative infections, with large cranioplasties having the higher risk (p<0.0001). Autograft usage did not significantly alter complication risk, mortality risk, or 30-day readmission rates. The total costs of care associated with cranioplasty were mainly driven by hospital payments, with physician payments comprising only a small amount.
Conclusions: We found a high complication rate associated with cranioplasty procedures in the United States. A stratification of our cohort by age, autograft usage, and size of the cranioplasty showed that elderly age and a larger cranioplasty size significantly increased overall complication risk. Autograft usage during the procedure did not affect outcomes after cranioplasty. The use of a longitudinal national database has allowed us valuable insight into the patient- and surgery-specific factors associated with cranioplasty outcomes.
Patient Care: Cranioplasty is becoming more widespread in response to the increasing use of craniectomies to manage intracranial pressure due to traumatic brain injury, ischemic stroke, or brain tumors. As the number of cranioplasty procedures continue to grow, it is important to assess its safety and complication profile. To our knowledge, our work is the first in the literature to characterize cranioplasty outcomes at a population level using a longitudinal national claims database. Such outcomes include postoperative complications, mortality, 30-day readmission rates, and costs of care. Our research will therefore enhance patient care and provide a valuable resource for clinicians and patients.
Learning Objectives: A high complication rate is associated with cranioplasty procedures in the United States.
Elderly age significantly increased overall complication risk after cranioplasty compared to pediatric and nonelderly adult patients.
A larger cranioplasty size (>5 cm) significantly increased overall complication risk.
Autograft usage during cranioplasty did not affect outcomes.
The total costs of care associated with cranioplasty were mainly driven by hospital payments, with physician payments comprising only a small amount.