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

OBJECTIVE: To characterize cranioplasty complications and costs at a population level using a longitudinal national claims database.

METHODS: We identified patients undergoing cranioplasty between 2007 and 2014 in the MarketScan national database. We evaluated age, autograft usage, cranioplasty size, and cranioplasty timing stratified by postoperative outcomes. We further analyzed associated costs. A subset analysis of adult patients with emergent indications, including stroke and trauma, was performed.

RESULTS: We identified 8275 patients (mean age 44.0 years ± 20.0, 45.2% male), including 13.8% children (<18 years old), 76.0% adults (18-64 years old), and 10.2% elderly adults (≥65 years old). Overall complication rate was 36.6%, mortality rate was 0.5%, and 30-day readmission rate was 12.0%. Elderly patients had the highest complication rate (P < 0.0001). Large cranioplasties (>5 cm) had higher complication rates than small cranioplasties (≤5 cm; P = 0.047). In patients with emergent indications (n = 1282), size did not influence complications, although large cranioplasties showed higher infection risk (P = 0.02). Autograft use did not affect outcomes but was associated with higher complication risk, including infections, in the subset with emergent indications (P < 0.001, P = 0.001). Late (>90 days) cranioplasty timing had higher complication rates in the overall cohort and the subset with emergent indications (P < 0.001, P < 0.001). Index costs of care were mainly driven by hospital payments in both the overall cohort and the cohort with emergent indications.

CONCLUSIONS: A high complication rate is associated with cranioplasty in the United States. Older age, large cranioplasties, and delayed cranioplasties increased complication risk overall. Among patients with emergent indications, complications were associated with delayed time to cranioplasty and autograft usage.