Cranioplasty outcomes and associated complications in Addis Ababa Burn, Emergency and Trauma Hospital: A retrospective Study

Abstract

Abstract Background: Repairing cranial deformities surgically known as cranioplasty is performed for both cosmetic purpose and therapeutic purposes. This study is the first of its kind to access patterns of complications and clinical and cosmetic outcome of patients who underwent cranioplasty in Ethiopian set up to the principal investigators knowledge. Objectives: This study describes patterns of complications and outcome of patients underwent cranioplasty and identify factors that affect outcome and complications. Methods: Institutional based cross sectional study design was used to collect data on cranioplasty performed for patients with skull defect from December 1 ,2021 to December 1 ,2023, G.C. Structured questionnaire was used to collect data from the charts and structured GOS and functional outcome questionnaire was used to collect data using in depth phone interview. Model fitness is checked with Hosmer and Lemeshow test found to be insignificant (>0.05). Univariate analysis was done for descriptive statistics using frequency, mean, median, range and standard deviation. Multivariate regression analysis was used to determine predictors of complications and outcome. Result: 40 patients were included in this study with 26 male 14 female patients and with male to female ratio of 1:1.8. The age ranges of the study population were 2 to 68 years of age with 77.5%of the study population were age below 40 years of age. The mean pre-cranioplasty GCS was 14.75 (R 11-15, SD 8.99) and the mean post cranioplasty GCS was 14.85 (R 11-15 SD 6.62). Postoperative GOS of the patients were 5 and 4 for 30(75%) and 9(22.5) respectively. All patients took perioperative antibiotics. All the study participants used postoperative sub-galleal drainage. Most of the cranioplasties 97.5% were performed on one side (unilateral). Duration of surgery for most cranioplasties extend from 1-3hours in 32(80%) of patients. Most patients have postoperative length of stay of 3 days 21(52.5%), while 10(25%), and of study participants have postoperative length of stay of more than 5 days. Intraoperative adverse event occurred in 2 (5%) of patients. 28(70%) of patients used autologous graft and remaining 12(30%) of patients used synthetic graft. All autologous bone was preserved in abdominal wall. 10(25%) of the patients underwent cranioplasty within 3 months while, 18(45%) of patients from 3-6months. The most common indication for cranioplasty is intraoperative brain swelling in 34(85%) of patients IV secondary to trauma 27(67.5%). Over all complication rate was 37.5% with seizure and wound infection or dehiscence account for 5(12.5%) each. The reoperation rate was 5(12.5%) with most of the re-operations were for wound infection or dehiscence. 35 (87.5%) of patients were very satisfied or satisfied with post-cranioplasty cosmetic outcome. Conclusion: Overall complication rate was 37.5% which is higher than reported in multiple studies. (2,3,7,22) Infection and seizure account for most of the complications. Patients who underwent cranioplasty for indication of assault by stone or stick were 14 times and by FDA were 3.892 times more likely to have complications. Patients with duration of surgery 3-4 hours were 6.28 times and 1-3hours have 1.34 times more likely to have complications with p value of <0.001. Favorable pre-cranioplasty GOS was 97.5% and Postoperative favorable GOS was seen in 97.5% of the study populations. 12.5% of the study population were not satisfied and request for cosmetic result. Patients favorable post-cranioplasty GOS has statistically significant association with pre-cranioplasty GOS with P value of <0.001. Those patients underwent cranioplasty with autologous bone are 1.83 time higher likelihood of need for cosmetic re-operation than those with synthetic graft cranioplasty with p value of 0.609 Key words: Cranioplasty, Cosmetic outcome, Clinical Outcome, Cranioplasty complications