Cranioplasty Complications and Costs: A National Population-Level Analysis Using the MarketScan Longitudinal Database

• Published in: World neurosurgery 2017-06, Vol.102, p.209-220
• Main Authors: Li, Amy, BA, Azad, Tej Deepak, BA, Veeravagu, Anand, MD, Bhatti, Inderpreet, BA, Long, Chao, AB, Ratliff, John K., MD, Li, Gordon, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Cohort Studies; Complication; Cost; Cranioplasty; Databases, Factual - statistics & numerical data; Decompressive Craniectomy - adverse effects; Female; Humans; Male; MarketScan; Medicare - statistics & numerical data; Middle Aged; Neurosurgery; Population; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Reconstructive Surgical Procedures - adverse effects; Timing; United States - epidemiology; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.03.022

Abstract Objective To characterize cranioplasty complications and costs at a population level using a longitudinal national claims database. Methods We identified cranioplasty patients between 2007-2014 in the MarketScan national database. We evaluated age, autograft usage, cranioplasty size, and cranioplasty timing on postoperative outcomes. We further analyzed associated costs. A subset analysis of adult cranioplasty patients with emergent indications, including stroke and trauma, was also performed. Results We identified 8,275 patients (mean 44.0±20.0 years, 45.2% male) consisting of 13.8% pediatric (65 years). Overall complication rate was 36.6%, mortality rate 0.5%, and 30-day readmission rate 12.0%. Elderly patients had the highest complication rate (p5 cm) saw higher complication rates than small cranioplasties (≤5 cm, p=0.047). In those with emergent indications only(N=1,282), size did not influence complications—though large cranioplasties showed higher infection risk (p=0.02). Overall, autograft use did not affect outcomes, but was associated with higher complication risk—including infections—in the subset with only emergent indications (p90 days) cranioplasty timing had higher complication rates in both the overall cohort and subset with emergent indications (p