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Polyetheretherketone (PEEK) Into the Future: Lowering Infection Rates in Cranioplasty
Evan B Hughes1, John Alfarone1, Evan S Chernov1
1Department of Otolaryngology, Head and Neck Surgery, State University of New York Upstate Medical University, Syracuse, USA.
Introduction:
Surgical site infection (SSI) is one of the most common complications following cranioplasty. At our institution, 3D printing has emerged as a popular option for creating customized polyetheretherketone (PEEK) cranioplasty implants that are lower profile than older, non-3D-printed implants. The 3D-printed implants can be integrated, with fixation plates already attached, or nonintegrated, with separate fixation plates available. To our knowledge, no study has analyzed the differences in infection rates between integrated and nonintegrated 3D-printed implants.
Objectives:
This study aimed to explore whether integrated 3D-printed cranioplasty implants lead to decreased infection risk and improved patient outcomes compared to nonintegrated 3D-printed implants and further aims include exploring how operating room time and hospital length of stay affect infection risk.
Methods:
A retrospective chart review of 197 patients who underwent cranioplasty surgery from 2012 to 2023 was conducted. The postcranioplasty infection rate was compared between the integrated and nonintegrated 3D implants. Pre- and postoperative antibiotic use, operating time, hospital stay length, and patient comorbidities were also evaluated. Statistical analysis was conducted using SPSS version 28.0 (IBM Corp., Armonk, NY). Initial bivariate statistics were utilized where appropriate, and ultimately, a binary logistic regression model was employed.
Results:
Our overall infection rate was 12.2%, higher than the national average of 7.89%. There was no significant association between the implant type and postcranioplasty infection. However, when controlling for the clinical and demographic covariates in our study, patients who had a Charlson comorbidity index (CCI) of 3-4 were 6.36 times as likely to experience a postcranioplasty infection when compared to their counterparts with a CCI of 0, OR of 6.36, 95% CI of 1.01-40.0, and a p value of 0.048. Additionally, with every one-year increase in age, the number of infections decreased by 0.955, with an OR of 0.955, 95% CI of 0.915-0.996, and a p value of 0.031.
Conclusions:
While there was no significant difference in SSI between the integrated and nonintegrated 3D-printed PEEK implants, elevated CCI and age were associated with a greater risk of infection. Our overall infection rate exceeds that reported in a recent large-scale review, which may be attributable to the higher average CCI typically observed in our tertiary care setting. Our findings illustrate that integrated and nonintegrated 3D implants offer viable and efficacious options for patients with cranial vault deformities requiring surgical repair.
