Zhou Qian, Shen Wei, Zhou Zhiying, Yang Xiaofeng, Wen Liang
The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Neurosurgery, Beilun People's Hospital in Ningbo, Ningbo, China.
Front Neurol. 2022 Oct 10;13:995897. doi: 10.3389/fneur.2022.995897. eCollection 2022.
The combination of cranioplasty and ventriculoperitoneal shunt is a therapeutic strategy for patients with hydrocephalus after decompressive craniectomy (DC). However, the efficacies of simultaneous vs. staged surgery in reducing postoperative complications have not been conclusively determined. This was a meta-analysis of relevant studies to assess whether simultaneous surgery significantly reduces postoperative complication risks, compared to staged surgery.
We systematically searched PubMed, Embase, Cochrane, Web of science databases for studies (published by 11 May 2022) comparing patients undergoing concurrent and staged cranioplasty and ventriculoperitoneal shunt. Our main endpoints were; overall postoperative complications, postoperative bleeding, postoperative infection and reoperation. We assessed the pooled data using a random effects model to compare complication rates using odds ratios (ORs) and 95% confidence intervals (CIs).
Of the 494 identified studies, 12 were included in our analysis ( = 651 participants). Compared to staged surgery, concurrent surgery increased the relative risk for overall complications (pooled OR: 2.00; 95% CI: 1.10-3.67), however, it did not increase the relative risks for postoperative bleeding, postoperative infection or reoperation. Subgroup analysis revealed that in the Asian population, concurrent surgery increased the relative risks for overall complications (staged vs. concurrent group: OR: 2.41, 95% CI: 1.51-3.83, = 0.0%) and postoperative infections (staged vs. concurrent group: OR: 2.35, 95% CI: 1.06-5.21, = 31.8%).
Compared to staged surgery, concurrent surgery increases the overall complication rates. However, differences between the two therapeutic approaches in terms of postoperative bleeding, postoperative infection, or reoperation are insignificant. Simultaneous surgery was associated with increased overall post-operative complications and post-operative infection rates in the Asian population.
颅骨修补术与脑室腹腔分流术联合应用是减压性颅骨切除术（DC）后脑积水患者的一种治疗策略。然而，同期手术与分期手术在降低术后并发症方面的疗效尚未得到最终确定。本研究是一项相关研究的荟萃分析，旨在评估与分期手术相比，同期手术是否能显著降低术后并发症风险。
我们系统检索了PubMed、Embase、Cochrane、Web of science数据库中截至2022年5月11日发表的比较同期和分期颅骨修补术与脑室腹腔分流术患者的研究。我们的主要终点是；总体术后并发症、术后出血、术后感染和再次手术。我们使用随机效应模型评估汇总数据，以比值比（OR）和95%置信区间（CI）比较并发症发生率。
在494项已识别的研究中，12项纳入我们的分析（n = 651名参与者）。与分期手术相比，同期手术增加了总体并发症的相对风险（汇总OR：2.00；95%CI：1.10 - 3.67），然而，它并未增加术后出血、术后感染或再次手术的相对风险。亚组分析显示，在亚洲人群中，同期手术增加了总体并发症（分期组与同期组：OR：2.41，95%CI：1.51 - 3.83，P = 0.0%）和术后感染（分期组与同期组：OR：2.35，95%CI：1.06 - 5.21，P = 31.8%）的相对风险。
与分期手术相比，同期手术增加了总体并发症发生率。然而，两种治疗方法在术后出血、术后感染或再次手术方面的差异不显著。同期手术与亚洲人群总体术后并发症和术后感染率增加有关。
