Cranioplasty with hydroxyapatite or acrylic is associated with a reduced risk of all-cause and infection-associated explantation


Millward, Christopher P ORCID: 0000-0001-7727-1157, Doherty, John A, Mustafa, Mohammad A, Humphries, Thomas J, Islim, Abdurrahman I, Richardson, George E, Clynch, Abigail L, Gillespie, Conor S, Keshwara, Sumirat M, Kolamunnage-Dona, Ruwanthi ORCID: 0000-0003-3886-6208 et al (show 5 more authors) (2022) Cranioplasty with hydroxyapatite or acrylic is associated with a reduced risk of all-cause and infection-associated explantation. BRITISH JOURNAL OF NEUROSURGERY, 36 (3). pp. 385-393.

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Abstract

<h4>Objective</h4>Cranioplasty remains an essential procedure following craniectomy but is associated with high morbidity. We investigated factors associated with outcomes following first alloplastic cranioplasty.<h4>Methods</h4>A single-centre, retrospective cohort study of patients undergoing first alloplastic cranioplasty at a tertiary neuroscience centre (01 March 2010-01 September 2021). Patient demographics and craniectomy/cranioplasty details were extracted. Primary outcome was all-cause explantation. Secondary outcomes were explantation secondary to infection, surgical morbidity and mortality. Multivariable analysis was performed using Cox proportional hazards regression or binary logistic regression.<h4>Results</h4>Included were 287 patients with a mean age of 42.9 years [SD = 15.4] at time of cranioplasty. The most common indication for craniectomy was traumatic brain injury (32.1%, n = 92). Cranioplasty materials included titanium plate (23.3%, n = 67), hydroxyapatite (22.3%, n = 64), acrylic (20.6%, n = 59), titanium mesh (19.2%, n = 55), hand-moulded PMMA cement (9.1%, n = 26) and PEEK (5.6%, n = 16). Median follow-up time after cranioplasty was 86.5 months (IQR 44.6-111.3). All-cause explantation was 12.2% (n = 35). Eighty-three patients (28.9%) had surgical morbidity. In multivariable analysis, the risk of all-cause explantation and explantation due to infection was reduced with the use of both hydroxyapatite (HR 0.22 [95% CI 0.07-0.71], <i>p</i> = .011, HR 0.22 [95% CI 0.05-0.93], <i>p</i> = .040) and acrylic (HR 0.20 [95% CI 0.06-0.73], <i>p</i> = .015, HR 0.24 [95% CI 0.06-0.97], <i>p</i> = .045), respectively. In addition, risk of explantation due to infection was increased when time to cranioplasty was between three and six months (HR 6.38 [95% CI 1.35-30.19], <i>p</i> = .020). Mean age at cranioplasty (HR 1.47 [95% CI 1.03-2.11], <i>p</i> = .034), titanium mesh (HR 5.36 [95% CI 1.88-15.24], <i>p</i> = .002), and use of a drain (HR 3.37 [95% CI 1.51-7.51], <i>p</i> = .003) increased risk of mortality.<h4>Conclusions</h4>Morbidity is high following cranioplasty, with over a tenth requiring explantation. Hydroxyapatite and acrylic were associated with reduced risk of all-cause explantation and explantation due to infection. Cranioplasty insertion at three to six months was associated with increased risk of explantation due to infection.

Item Type: Article
Uncontrolled Keywords: Cranioplasty, morbidity, mortality, titanium, acrylic, hydroxyapatite
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Population Health
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 07 Jul 2022 10:20
Last Modified: 18 Jan 2023 20:56
DOI: 10.1080/02688697.2022.2077311
Open Access URL: https://doi.org/10.1080/02688697.2022.2077311
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3157935
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