Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Perioperative Anticoagulation Increases the Risk of Complications After Cranioplasty
Eric W. Sankey, BS1, Joseph Lopez, MD, MBA2, Shuting Zhong, BS3, Ignacio Jusue-Torres, MD2, Jason Liauw, MD2, Judy Huang, MD2, Michael Streiff, MD2, Henry Brem, MD2, Chad Gordon, DO2.
1Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2Johns Hopkins Hospital, Baltimore, MD, USA, 3University of Illinois College of Medicine, Rockford, IL, USA.

Purpose - Despite advancements in materials and techniques used for cranial reconstruction, complication rates following cranioplasty remain significant. Understanding patient-specific risk factors and their relation to certain complications are essential for optimizing patient safety. This study determines risk factors associated with minor/major complications in patients undergoing reconstructive cranioplasty for large-sized skull defects (>5cm2).
Methods - Retrospective cohort review of 108 consecutive patients who underwent cranioplasty (>5cm2) by a single team between 2011 and 2014 was conducted. The association of several perioperative variables with minor (i.e. not requiring surgical intervention) and major (i.e. surgical intervention required) complications were assessed. Multivariate logistic regression analysis was performed with forward selection of significant variables on an univariate analysis.
Results - Twenty-three (21.3%) primary and 85 (78.7%) secondary cranioplasties were performed on 94 patients with a median age of 50 (38-63) years. Median full thickness calvarial defect size was 154 (104-230) cm2. Nine (9.6%) patients presented with chronic anticoagulant therapy for pre-existing conditions and therefore required peri-operative anticoagulation (e.g. intravenous heparin). Eleven (10.2%) minor and 18 (16.7%) major postoperative complications occurred in 26 (24.1%) cases. Multivariate logistic regression analysis revealed that only peri-operative therapeutic anticoagulation (OR=7.01, 95% CI 1.24-51.6, p=0.034) and “other comorbidities” (OR=5.67, 95% CI 1.28-38.3, p=0.040) remained statistically significant in predicting complications. Of note, the affect of antiplatelet therapy was not assessed.
Conclusion - To our knowledge, this is the first study to document that the use of peri-operative anticoagulant therapy for patients with thromboembolic conditions is a positive predictor of complications following cranioplasty.


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