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Comparison of Postoperative Surgical-Site Infection and Symptomatic Intracranial Hemorrhage between Staged and Simultaneous Cranioplasty with Ventriculoperitoneal Shunt Placement: A Meta-Analysis

Korean Journal of Neurotrauma 2020년 16권 2호 p.235 ~ 245
정훈교, 장경민, 최현호, 남태균, 박용숙, 권정택,
소속 상세정보
정훈교 ( Jung Hoon-Kyo ) - Chung-Ang University College of Medicine Chung-Ang University Hospital Department of Neurosurgery
장경민 ( Jang Kyoung-Min ) - Chung-Ang University College of Medicine Chung-Ang University Hospital Department of Neurosurgery
최현호 ( Choi Hyun-Ho ) - Chung-Ang University College of Medicine Chung-Ang University Hospital Department of Neurosurgery
남태균 ( Nam Taek-Kyun ) - Chung-Ang University College of Medicine Chung-Ang University Hospital Department of Neurosurgery
박용숙 ( Park Yong-Sook ) - Chung-Ang University College of Medicine Chung-Ang University Hospital Department of Neurosurgery
권정택 ( Kwon Jeong-Taik ) - Chung-Ang University College of Medicine Chung-Ang University Hospital Department of Neurosurgery

Abstract


Objective: Consensus about the sequence of cranioplasty and ventriculoperitoneal shunt placement to reduce postoperative complications has not been established. This meta-analysis investigated and collated further evidence to determine whether staged cranioplasty with ventriculoperitoneal shunt placement would significantly reduce the risk of postoperative surgical-site infection (SSI) and symptomatic intracranial hemorrhage.

Methods: Two independent reviewers identified articles and extracted the data of patients who underwent cranioplasty and ventriculoperitoneal shunt placement from PubMed, Embase, and Cochrane Central Register of Controlled Trials. A random effects model was used to compare the complication rates using odd ratios (ORs) and 95% confidence intervals (CIs). A meta-regression analysis for traumatic brain injury (TBI) was additionally performed.

Results: Data from 7 studies with 391 patients were consecutively included. The meta-analysis revealed that staged surgery was significantly associated with lower rates of SSI after decompressive craniectomy (staged group vs. simultaneous group: 6.2% vs. 23.7%, OR: 2.72, 95% CI: 1.46?5.06, I2=2.4%, p=0.407). Pooled analysis did not indicate a statistically significant difference between the 2 groups for symptomatic intracranial hemorrhage (staged group vs. simultaneous group: 10.4% vs. 23.0%, OR: 1.66, 95% CI: 0.74?3.73, I2=0.0%, p=0.407). The meta-regression analysis did not indicate any modifying effect of TBI on postoperative SSI development (p=0.987).

Conclusion: This meta-analysis indicated that staged surgery is significantly associated with a lower rate of postoperative SSI as compared with simultaneous surgery, but there is no difference in symptomatic intracranial hemorrhage. Additionally, there is no modifying effect of TBI on SSI.

키워드

Cranioplasty; Ventriculoperitoneal shunt; Craniectomy; Infection; Intracranial hemorrhage

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