Article
Is there a correlation between neurosurgical experience and complication rate after cranioplasty with customised implants?
Existiert eine Korrelation zwischen neurochirurgischer Erfahrung und Komplikationsrate nach Kranioplastie mit individuell angefertigten Implantaten?
Search Medline for
Authors
-
Christina Wolfert
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
-
Veit Rohde
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
-
Dorothee Mielke
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
| Published: | May 8, 2019 |
|---|
Outline
Text
Objective: Cranioplasty is considered to be an easy neurosurgical intervention and is often performed by neurosurgical residents with limited operative experiences. Clinical studies have shown that a prolonged duration of surgery does increase the risk of surgery-associated infection. In conclusion, the postoperative infection rate should be higher in young and unexperienced neurosurgeons, since one might suspect that their interventions are associated with a prolonged duration of operation.
Hence, we conducted a retrospective single center study comparing re-operation rate and infection rate depending on the neurosurgeons experience.
Methods: We retrospectively analyzed the data of a consecutive series of 39 patients (20f, 19m) that received customized implants (Craniomosaic, OssDsign) after decompressive hemicraniectomy. Patients follow up encompassed at least one month. Surgeons were categorized in III groups.
- Group I: Senior consultants with at least 10 years of neurosurgical experience
- Group II: consultants with less than 10 years of experience and
- Group III: residents
Mean duration of surgery in minutes (min) was recorded. P-value was calculated using the Chi2-Test, with a significance value of p <0.05.
Results: In total, mean duration of surgery was 141 min (range 79–254). Over all, four (10.3%) customized implants were removed because of wound infection, involving the implant. Senior consultants were in charge of sixteen surgeries (41.0%) with a mean duration of 151 min (SD: 47) , whereas group III surgeons performed 9 surgeries (23.1%) (mean duration: 135 min, SD: 39). In this group, two (22.2%) customized implants required explantation due to wound infections (p=0.07). The remaining fourteen surgeries (35.9%) were conducted by group II surgeons (mean duration: 147 min SD: 51) with an explantation rate of 14.3% (n=2, p=0.14).
Conclusion: Although duration of surgery was longest in senior consultants, it was still associated with the lowest explantation rate. Even though not significant, explantation rate was highest in junior consultants, followed by residents. A bias due to patient collection seems most likely, since patients with more challenging wound conditions, that require a rotational skin flap for example, are operated by a consultant. In conclusion, we suggest to handle implantation of customized implants with care and to be aware of the elevated infection rate in less experienced surgeons.
