Health-related quality of life following cranioplasty: a cross-sectional cohort study - Cranio-PRO

Cranioplasty is an operation that aims to repair a defect in the skull. Indications commonly include Traumatic Brain Injury (TBI), tumours, and infections. It carries a high rate of postoperative morbidity. Due to underlying pathology and the nature of the operation patients' Health-related Quality of life (QoL) can be severely affected. Patient reported outcomes (PROs) are poorly understood following cranioplasty. To investigate PROs following cranioplasty a cross-sectional cohort study of adults undergoing cranioplasty between 01/03/2010-30/08/2020 was conducted. If consent was provided, participants were sent five health reporting questionnaires: a study specific questionnaire, EuroQoL - 5D - 5L (EQ-5D-5L), RAND Short-Form 36 (SF-36), Hospital Anxiety and Depression Scale (HADS), and Derriford Appearance Scale (DAS-24). 239 eligible patients were contacted and 72 (30.8%) participated. Median [Range] age was 52.5 [23 - 95] of which 59.7% (n= 43) were male. 16.9% (n = 12) were categorised with borderline and 29.0% (n = 20) with extreme depression, 15.9% (n = 11) reported borderline and 35.2% (n = 25) extreme anxiety. 69.1% (n = 47) had problems with usual activities and 71.6% (n = 49) suffered from pain/discomfort. Median (Range) EQ-5D-5L visual analogue scale score for overall health was 70.0 (5-100). 76.0% (n = 53) reported feeling conscious or having negative feelings towards their appearance. When compared to normative UK population, physical functioning, overall health, and energy/fatigue were the most affected. After cranioplasty, patients may have reduced HRQoL. Signposting and referral to well-being services could benefit patients' care. Adequately powered longitudinal studies are required to further elucidate change in PROs following cranioplasty.