Renewed focus on neurosurgical health care quality metrics dictates critical evaluation of current practices and their impact on postoperative complications, hospital costs and patient outcomes. Cranioplasty procedures in both adult and pediatric patients have been traditionally been associated with significant perioperative complications. Consensus on modifiable risk factors such as timing of surgery, nature of implants, CSF diversion and infection control measures are lacking. A multi-institutional retrospective registry-based study analyzes cranioplasty outcomes in pediatric patients to address 2 primary endpoints: infection and flap resorption. The predominant subgroup are patients with decompression for traumatic injury. Overall infection rate was 10.5% with cranial implants (shunts or bone implant), presence of gastrostomy and ventilator dependence status as significant predictors on multivariate analysis. These two risks factors may be potential surrogates for overall health and nutritional status. Overall rate of resorption was 21.7% with young age identified as a significant risk factor on multivariate analysis. In clinical practice, these risk factors are seldom modifiable, and may guide risk stratification in pediatric cranioplasty. Other possible risk factors identified in univariate analyses may be validated via prospective longitudinal studies to improve quality, healthcare costs and advance care of pediatric neurosurgical patients.
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