J Korean Neurosurg Soc.  2012 Oct;52(4):396-403. 10.3340/jkns.2012.52.4.396.

Long-Term Incidence and Predicting Factors of Cranioplasty Infection after Decompressive Craniectomy

• Im SH
• Jang DK
• Han YM
• Kim JT
• Chung DS
• Park YS

• KMID: 2190659
• DOI: http://doi.org/10.3340/jkns.2012.52.4.396

Abstract

OBJECTIVE
The predictors of cranioplasty infection after decompressive craniectomy have not yet been fully characterized. The objective of the current study was to compare the long-term incidences of surgical site infection according to the graft material and cranioplasty timing after craniectomy, and to determine the associated factors of cranioplasty infection.
METHODS
A retrospective cohort study was conducted to assess graft infection in patients who underwent cranioplasty after decompressive craniectomy between 2001 and 2011 at a single-center. From a total of 197 eligible patients, 131 patients undergoing 134 cranioplasties were assessed for event-free survival according to graft material and cranioplasty timing after craniectomy. Kaplan-Meier survival analysis and Cox regression methods were employed, with cranioplasty infection identified as the primary outcome. Secondary outcomes were also evaluated, including autogenous bone resorption, epidural hematoma, subdural hematoma and brain contusion.
RESULTS
The median follow-up duration was 454 days (range 10 to 3900 days), during which 14 (10.7%) patients suffered cranioplasty infection. There was no significant difference between the two groups for event-free survival rate for cranioplasty infection with either a cryopreserved or artificial bone graft (p=0.074). Intergroup differences according to cranioplasty time after craniectomy were also not observed (p=0.083). Poor neurologic outcome at cranioplasty significantly affected the development of cranioplasty infection (hazard ratio 5.203, 95% CI 1.075 to 25.193, p=0.04).
CONCLUSION
Neurologic status may influence cranioplasty infection after decompressive craniectomy. A further prospective study about predictors of cranioplasty infection including graft material and cranioplasty timing is necessary.

Keyword

Decompressive craniectomy; Cranioplasty infection; Neurologic outcome; Graft material; Cranioplasty timing

MeSH Terms

Bone Resorption
Brain
Cohort Studies
Decompressive Craniectomy
Disease-Free Survival
Follow-Up Studies
Hematoma
Hematoma, Subdural
Humans
Incidence
Retrospective Studies
Transplants

Figure

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  Fig. 1 Flow chart of participants in the retrospective cohort from 2001 to 2011.

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  Fig. 2 Kaplan-Meier event-free survival curves at 10 years for cranioplasty infection according to graft material (p=0.074) (A), and cranioplasty timing (p=0.083) (B) in 131 cranioplasty patients, and according to sterilization methods (p=0.146) (C) in 83 patients who underwent cranioplasty with a cryopreserved bone graft.

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  Fig. 3 Postoperative complications within 2 weeks after cranioplasty. EDH, SDH, NA and NC stand for epidural hematoma, subdural hematoma, not applicable and not checked, respectively. Numbers in parentheses indicate the number of patients.

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