Skull Repair Timing and Six-Month Risk Signals

After a decompressive craniectomy, a later skull reconstruction may not be just a scheduling choice. It may affect what happens next. About 3 in 10 patients who need cranioplasty can have a postoperative problem. Surgeons still debate whether doing the repair soon after the first operation is safer, or whether waiting lowers risk. Each timing option can bring benefits, but the available evidence has not given a clear answer.

To study this, researchers looked back at TriNetX records. They grouped patients by when they had cranioplasty after craniectomy. The early group had surgery from day 0 through day 90. The late group had surgery from day 91 through one year. The team balanced the groups using demographics, major health problems present before surgery, and anticoagulant use. They then checked for seizures, bleeding inside the brain, hydrocephalus, wound infection, and infection inside the skull within six months after cranioplasty. They used unadjusted odds ratios with 95% confidence intervals to compare rates. Kaplan-Meier survival analysis and log-rank tests were used for mortality.

The full set included 2,761 patients. Of these, 1,140 had early cranioplasty and 1,621 had late cranioplasty. The average age was 42.5 years in the early group and 43 years in the late group. Men made up 66% of the early group and 69% of the late group. After matching, each group had 994 patients. The early group had more intracerebral hemorrhage, with an odds ratio of 2.06 and a 95% confidence interval of 1.05 to 4.05. It also had more hydrocephalus, with an odds ratio of 1.76 and a 95% confidence interval of 1.05 to 2.96.

Other complications also leaned higher in the early group. Seizures occurred in 16.39% of early patients and 12.59% of late patients, with an odds ratio of 1.36 and a 95% confidence interval of 0.97 to 1.91. Wound infection appeared in 7.64% versus 6.13%, with an odds ratio of 1.27 and a 95% confidence interval of 0.89 to 1.80. Intracranial infection appeared in 2.33% versus 1.12%, with an odds ratio of 2.11 and a 95% confidence interval of 0.99 to 4.50. Six-month mortality was higher after early cranioplasty, with an odds ratio of 2.11, a 95% confidence interval of 1.32 to 3.37, and P = 0.0007. These results point to timing as an important factor, but prospective studies are still needed, especially ones that include patient goals and views.