When the practice does not meet the theory: results from an Italian survey on the clinical and pathway management of inpatients with decompressive craniectomy or cranioplasty admitted to rehabilitation.
Fabio LA Porta, Rita Formisano, Corrado Iaccarino and 4 others
PMID 37204813WHAT IT FOUND
Italian neurorehabilitation physicians reported significant delays in cranioplasty, with 45% of patients waiting over three months.
Most felt clinical pathways were too slow, contradicting guidelines that urge early surgery. More than half identified the lack of clear guidelines as the primary barrier to improving patient outcomes.
Key findings
01Nearly half of patients with decompressive craniectomy were waiting more than three months for cranioplasty, and only about half of those were actually scheduled.
02Physicians reported long waiting times for transfer to neurosurgery and long overall clinical pathway durations, disagreeing with consensus recommendations to expedite surgery.
03Over half of the respondents stated that clear guidelines were the single factor that could positively impact patient outcomes.
STILL TO COME
How it was doneWhat they found
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What it does not show
The sample is not fully representative of all Italian rehabilitation centers. The study relies on physician opinions and aggregated data rather than direct patient records or prospective outcome tracking. Demographic details such as age and gender were not collected. The survey was conducted before the COVID-19 pandemic, so it does not reflect changes in care pathways caused by the health crisis. The comparison with consensus guidelines is limited because the guidelines focused on traumatic brain injury while the survey included all causes of severe acquired brain injury.
Declared interests
The authors declared no conflicts of interest. The study received no commercial sponsorship, though publication costs were supported by the Italian Ministry of Health.
The easy way to misread this
Do not interpret the reported delays and guideline discrepancies as proof that cranioplasty improves functional recovery. This study describes the system's failure to act quickly, not the clinical outcome of the surgery itself.