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Does Pre-hydrated Demineralized Bone Matrix Increase Inflammation and Drain Output in Cranial Vault Reconstruction? A Case - Control Study
Vikas S. Kotha MD, Sven Gunther MD, Robert P. Lesko BA, Brian Rothstein MD, Krystal Tomei MD, Anand R. Kumar M, Edward H. Davidson MD
Case Western Reserve University
2021-02-15
Presenter: Vikas S. Kotha MD
Affidavit:
100% of this project represents the original work of the resident
Director Name: Edward Davidson
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND: Demineralized bone matrices (DBMs) are commercially available as prehydrated (pDBM) or dehydrated (rDBM) requiring intraoperative rehydration. The effects of prehydration vs. rehydration on inflammation, drain output, and hospital stay are understudied. We hypothesize that rehydrated rDBM is associated with lower pyrogenicity, drainage volume, and hospital stay. The aim of this study is to compare differences in post-surgery outcomes using prehydrated or rehydrated DBM in cranial vault remodeling (CVR).
METHODS: A retrospective study (2019-2020) was performed evaluating patients with sagittal craniosynostosis treated with Pi Hungspan Cranioplasty and DBM. The primary predictive variable was allograft type: prehydrated pDBM and rehydrated rDBM. Primary outcome variables were maximum temperature in first 24 hours (24hr Tmax), total drain output, time until drain removal, and length of stay (LOS). Standard statistical analyses were performed using SPSS 27.
RESULTS: Thirteen patients met inclusion: n=8 in pDBM and n=5 in rDBM. The 24hr Tmax was 37 ºC (pDBM) vs. 36.4 ºC (rDMB) (p=0.02). Median time until drain removal was 110 hours (pDBM) vs. 96 hours (rDBM) (p=0.05). Total drain output was (437.8 mL pDBM vs. 436.3 mL rDBM, p=0.9); average drain output was 3.9 ml/hr pDBM vs 4. ml/hr rDBM p=0.8. Median LOS for pDBM was 5 days (95% CI, 4.2-5.3 d) vs. 4d (95% CI, 4-4 d) for rDBM (p=0.02).
CONCLUSION: Intraoperative rehydrated DBM allografts used in cranial vault remodeling surgery is associated with less fever, faster time to removal of surgical drains and shorter length of stay when compared to prehydrated DBM allograft despite similar daily drain output.
