Factors Associated With Infection-related Failure in Autologous Cranioplasty for Traumatic Brain Injury: A Matched
Huy Ngoc Pham1, Nguyen Cong Tien Anh2, Linh Khanh Nguyen2
1Department of Neurosurgery, Viet Duc University Hospital, Hanoi, Vietnam.
Objective:
This study aimed to identify associated factors of infection-related failure in autologous cranioplasty for traumatic brain injury in Vietnam.
Methods:
This was a matched case-control study with cases including patients with surgical site infection requiring bone flap removal following autologous cranioplasty for traumatic brain injury at Viet Duc University Hospital in Vietnam from January 2022 to July 2025. Each case was matched with 2 controls who had cranioplasty performed on the same or closest days as the case, preferably in the same operating room, and had no infection complications.
Results:
The case group consisted of 102 patients (87 males and 15 females; mean age 40 years), the control group included 204 patients (172 males and 32 females; mean age 40 years). Surgical site infections occurred early (≤30 days) in 31%, between 30 and 90 days in 29%, and after 90 days in 40% of the case group. Staphylococcus aureus was the most common pathogen, found in 60% of all positive culture specimens. Four factors associated with post-cranioplasty infection were early timing of cranioplasty (OR: 3.96, 95% CI: 1.86-8.43), frontal sinus fracture (OR: 7.84; 95% CI: 1.38-44.53), postoperative epidural fluid collection (OR: 2.84, 95% CI: 1.34-6.04) and large bone flap size (>110 cm2) (OR: 4.32, 95% CI: 1.54-12.15).
Conclusions:
In our study, time interval between decompressive craniectomy and cranioplasty less than three months, frontal sinus fracture, postoperative epidural hematoma and large bone flap were found to increase the likelihood of infection-related failure in cranioplasty.
Insights
Early cranioplasty (less than three months post-injury), frontal sinus fractures, postoperative fluid collections, and large bone flaps increase infection risk after traumatic brain injury surgery.
Area of Science:
- Neurosurgery
- Infectious Disease Epidemiology
Background:
- Autologous cranioplasty is a common procedure for traumatic brain injury (TBI).
- Infection remains a significant complication, leading to potential failure and morbidity.
Purpose of the Study:
- To identify factors associated with infection-related failure in autologous cranioplasty for TBI in Vietnam.
- To inform preventative strategies and improve patient outcomes.
Main Methods:
- A matched case-control study was conducted at Viet Duc University Hospital.
- Cases with surgical site infection requiring bone flap removal were matched with controls without infection.
- Data were collected from January 2022 to July 2025.
Main Results:
- Four hundred two patients (102 cases, 204 controls) were included.
- Key risk factors identified: early cranioplasty (≤3 months), frontal sinus fracture, postoperative epidural fluid collection, and large bone flap size (>110 cm²).
- Staphylococcus aureus was the most frequent pathogen identified.
Conclusions:
- Timely intervention, specific fracture patterns, fluid accumulation, and graft size are critical factors influencing post-cranioplasty infection.
- These findings highlight targets for reducing infection-related cranioplasty failure.
