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Reoperation Risk Factors for Cranioplasty Surgery. BACKGROUND AND OBJECTIVES: Adverse events after cranioplasty remain a significant burden in postsurgical care, often necessitating reoperations. Identifying predictors of reoperation could optimize care. We investigated reoperation after cranioplasty and factors that correlate. METHODS: A retrospective analysis of 318 cranioplasty patients at our single institution was conducted. Clinical demographics, preoperative and perioperative parameters, and postoperative outcomes of patients were collected from electronic health records. Univariable and multivariable logistic regression were conducted to identify significant predictors of reoperation after cranioplasty. Patients who had previous cranioplasties or the bone flap replaced during the craniectomy were excluded. RESULTS: Of 318 cranioplasty patients, 62 (19.4%) required reoperation. These patients had shorter time intervals between craniectomy and cranioplasty relative to patients who did not require reoperation (median of 86 vs 140 days, IQR: 31-164 and 79-211, P ≤ .01). The reoperation group also had a greater frequency of cranioplasties done during their index hemicraniectomy hospital stay (21.3% vs 10.9%, P = .03), longer time interval to restarting antiplatelets or anticoagulants (median of 34 vs 11 days, IQR 18-102 and 7-16, P = .03), greater number of preoperative ventriculoperitoneal shunt patients (26.2% vs 12.9%, P = .01), and lower utilization of autologous bone implant (62.3% vs 80.0%, P ≤ .01). On multivariable analysis, use of autologous bone implant (odds ratio: 0.38 [0.15-0.94], P = .03) and postoperative subgaleal drain use (odds ratio: 0.35 [0.13-0.91], P = .03) were associated with a lower odds of reoperation, while greater fluid collection on postoperative computed tomography was linked to a higher odds of reoperation (odds ratio: 1.05 [1.01-1.11], P = .02). CONCLUSION: Autologous bone implant, postoperative subgaleal drain use, and fluid collection on postoperative computed tomography are independent predictors of reoperations after cranioplasty. Further assessment of these factors may be beneficial for predictive modeling and surgical management of patients requiring cranioplasty.