Authors

Mario Zanaty, Department of Neurological Surgery, Thomas Jefferson UniversityFollow
Nohra Chalouhi, MD, Department of Neurological Surgery, Thomas Jefferson University Hospital, Thomas Jefferson UniversityFollow
Robert M Starke, Department of Neurological Surgery, University of VirginiaFollow
Rohan Chitale, MD, Department of Neurological Surgery, Thomas Jefferson University Hospital, Thomas Jefferson UniversityFollow
Shannon Hann, MD, Department of Neurological Surgery, Thomas Jefferson University Hospital, Thomas Jefferson UniversityFollow
Cory D Bovenzi, Department of Neurological Surgery, Thomas Jefferson University Hospital, Thomas Jefferson UniversityFollow
Mark P Saigh, Department of Neurological Surgery, Thomas Jefferson University Hospital, Thomas Jefferson UniversityFollow
Eric W Schwartz, Department of Neurological Surgery, Thomas Jefferson University Hospital, Thomas Jefferson UniversityFollow
Emily S I Kunkel, Department of Neurological Surgery, Thomas Jefferson University Hospital, Thomas Jefferson UniversityFollow
Alexandra S Efthimiadis-Budike, Department of Neurological Surgery, Thomas Jefferson University Hospital, Thomas Jefferson University
Pascal Jabbour MD, Department of Neurological Surgery, Thomas Jefferson University Hospital, Thomas Jefferson UniversityFollow
richard dalyai, Department of Neurological Surgery, Thomas Jefferson University Hospital, Thomas Jefferson UniversityFollow
Robert H. Rosenwasswer MD, Department of Neurological Surgery, Thomas Jefferson University Hospital, Thomas Jefferson UniversityFollow
Stavropoula Tjoumakaris, Department of Neurological Surgery, Thomas Jefferson University Hospital, Thomas Jefferson UniversityFollow

Document Type

Article

Publication Date

10-22-2014

Comments

This article has been peer reviewed. It was published in: Scientific World Journal.

Volume 2014, 2014, Article number 356042.

The published version is available at DOI: 10.1155/2014/356042

Copyright © 2014 Mario Zanaty et al.

Abstract

Introduction. The variables that predispose to postcranioplasty infections are poorly described in the literature. We formulated a multivariate model that predicts the risk of infection in patients undergoing cranioplasty. Method. Retrospective review of all patients who underwent cranioplasty following craniectomy from January, 2000, to December, 2011. Tested predictors were age, sex, diabetic status, hypertensive status, reason for craniectomy, urgency status of craniectomy, location of cranioplasty, reoperation for hematoma, hydrocephalus postcranioplasty, and material type. A multivariate logistic regression analysis was performed. Results. Three hundred forty-eight patients met the study criteria. Infection rate was 26.43% (92/348). Of these cases with infection, 56.52% (52/92) were superficial (supragaleal), 43.48% (40/92) were deep (subgaleal), and 31.52% (29/92) were present in both the supragaleal and subgaleal spaces. The predominant pathogen was coagulase-negative staphylococcus (30.43%) followed by methicillin-resistant Staphylococcus aureus (22.83%) and methicillin-sensitive Staphylococcus aureus (15.22%). Approximately 15.22% of all cultures were polymicrobial. Multivariate analysis revealed convex craniectomy, hemorrhagic stroke, and hydrocephalus to be associated with an increased risk of infection (OR = 14.41; P < 0.05, OR = 4.33; P < 0.05, OR = 1.90; P = 0.054, resp.). Conclusion. Many of the risk factors for infection after cranioplasty are modifiable. Recognition and prevention of the risk factors would help decrease the infection's rate.

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