D47. Predictive Factors for Outcomes in Alloplastic Cranioplasty: A Review of 101 Cases

PURPOSE: To describe factors related to functional and aesthetic outcomes in alloplastic cranioplasty. METHODS: The authors conducted a large-scale retrospective review of patients who underwent alloplastic cranioplasty between 2014 and 2021 at a single institution. Information was collected regarding demographics, wound healing comorbidities, indications for surgery, and outcomes. A multivariable regression analysis was used to determine variables associated with operative complications, implant explantation, and contour defects. RESULTS: One hundred and one patients underwent alloplastic cranioplasty. Fifty-seven percent of patients had at least one wound healing comorbidity. The most frequent indications for surgery were trauma (44%), cerebrovascular accident (18%), and cancer (18%). The operative complication rate was 24%. Thirty-six percent of patients had a postoperative contour deformity, and 16% underwent additional surgeries related to cosmesis. At a median follow-up of 1.5 years, 99% of patients maintained either a primary (84%) or secondarily placed (15%) implant. On multivariable analysis, level four ASA classification (OR 5.9, 95% CI [1.03, 33.1], p = 0.05) and heavy alcohol use (OR 6.2, 95% CI [1.5, 25.5], p = 0.01) were significantly associated with complications. Cerebrovascular accident was associated with contour defects (OR 6.1, 95% CI [1.2, 30.7], p = 0.03). The only factor associated with explantation was heavy alcohol use (p = 0.05). CONCLUSION: This study reviews predictive factors for complications, implant explantation, and poor contour outcomes after alloplastic cranioplasty in a large cohort. Results indicate that alloplastic cranioplasty can have a high success rate with reasonable aesthetic outcomes.