The Current Analysis of the Risk Factors for Bone Graft Infection after Cranioplasty

Sang-Mi Yang; Hyung-Ki Park; Sung-Jin Cho; Jae-Chil Chang; Sukh-Que Park; Ra-Sun Kim

doi:10.13004/kjnt.2013.9.2.57

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Yang, Park, Cho, Chang, Park, and Kim: The Current Analysis of the Risk Factors for Bone Graft Infection after Cranioplasty

Clinical Article

Korean J Nutr 2013;9(2):57-63.

Published online: 20 October 2013

DOI: https://doi.org/10.13004/kjnt.2013.9.2.57

The Current Analysis of the Risk Factors for Bone Graft Infection after Cranioplasty

Sang-Mi Yang, MD, Hyung-Ki Park, MD, Sung-Jin Cho, MD, Jae-Chil Chang, MD, Sukh-Que Park, MD, Ra-Sun Kim, MD

Department of Neurosurgery, Soonchunhyang University Hospital, Seoul, Korea

Address for correspondence: Hyung-Ki Park, MD Department of Neurosurgery, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea Tel: +82-2-709-9268, Fax: +82-2-792-5976 E-mail: phk007@schmc.ac.kr

Received 2 April 2013 Revised 8 July 2013 Accepted 8 July 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

The aim of this study is to investigate the factors that may be related to bone graft infection and to contribute to lower the infection rate. According to current studies, the rate of bone graft infection after cranioplasty was reported up to 15.9% and this is significantly high. There are many analyses of the factors influencing bone graft infection, but this issue may need to be reconsidered in that the current medical environment is ever-changing.

Methods

We retrospectively reviewed the demographic, clinical data of 130 patients who underwent cranioplasty following decompressive craniectomy from January 2004 to December 2011. We analyzed several factors influencing bone graft infection and divided them into three categories of clinical, operation-related and hematological factors including white blood cell count, erythrocyte sedimentation rate, C-reactive protein and albumin. Statistical significance was done by chi-square test, Fisher's test and Mann-Whitney U test.

Results

The infection occurred in 12 patients in 130 cranioplasties (9.2%). There was no difference in infection rate between each group of early and later surgery, graft material, cause of craniectomy. Among many factors, low Glasgow Coma Scale (GCS≤8) and combined ventriculoperitoneal (VP) shunt were significantly correlated with bone graft infection (p= 0.025, p=0.025, respectively). There was no statistically significant difference in hematological analysis between groups.

Conclusion

Low GCS and combined VP shunt with cranioplasty may increase the risk of bone graft infection.

Keywords: Cranioplasty, Craniectomy, Infection, Risk factor

References

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TABLE 1.

Patient demographics

Variables	Number of patients (%)
Number of patients	130
Male	91 (70.0)
Female	39 (30.0)
Age (years±SD)	54.0±17.4
Male	56.1±21.7
Female	53.7±15.1
Mean follow-up period (months±SD)	24.7±18.5
Initial diagnosis
Trauma	62 (47.7)
Non-trauma	68 (52.3)
Vascular	54 (79.4)
Subarachnoid hemorrhage	39 (57.4)
Cerebral infarction	15 (22.0)
Hypertensive ICH	7 (10.3)
Brain tumor	7 (10.3)
Time interval between craniectomy and cranioplasty (months±SD)	3.22±1.6
Graft material
Autogenous	107 (82.3)
Allogenous	23 (17.7)
Operation time (minutes±SD)	162.4±107.9
Autogenous	154.5±80.5
Allogenous	216.5±127.4
GCS before cranioplasty
＞8	109 (83.8)
≤8	21 (16.2)
Number of previous operation
1	97 (74.6)
2	22 (16.9)
3	8 (6.2)
4	3 (2.3)
Combined VP shunt
Yes	21 (16.2)
No	109 (83.8)

SD: standard deviation, GCS: Glasgow Coma Scale, VP: ventriculoperitoneal, ICH: intracerebral hematoma

TABLE 2.

Clinical factors for bone graft infection after cranioplasty

Variables	Infection (+) n=12	Infection (−) n=118	Total (%) n=130	p-value
Mean age, years	48.0	54.6	54.0	0.097
Sex				1.000
Male	9 (6.9%)	82 (63.1%)	91 (70.0%)
Female	3 (2.3%)	36 (27.7%)	39 (30.0%)
Medical Cormobidities
HTN	2 (1.5%)	35 (26.9%)	37 (28.5%)	0.507
DM	1 (0.8%)	23 (17.7%)	24 (18.5%)	0.695
Cause of craniectomy				0.767
Trauma	5 (3.8%)	57 (43.8%)	62 (47.7%)
Non-trauma	7 (5.4%)	61 (46.9%)	68 (52.3%)
GCS before cranioplasty				0.025
＞8	7 (5.4%)	102 (78.5%)	109 (83.8%)
≤8	5 (3.8%)	16 (12.3%)	21 (16.2%)
Time interval, months				0.562
＜2 months	5 (3.8%)	57 (43.8%)	62 (47.7%)
≥2 months	7 (5.4%)	61 (46.9%)	68 (52.3%)

HTN: hypertension, DM: diabetes mellitus, GCS: Glasgow Coma Scale

TABLE 3.

Operation related factors for bone graft infection after cranioplsty

Variables	Infection (+) n=12	Infection (−) n=118	Total n=130	p-value
No. prev. operation				0.331
1 time	7 (5.4%)	85 (65.4%)	92 (70.8%)
more than 2 times	5 (3.8%)	33 (25.4%)	38 (29.2%)
Mean operation time, minutes±SD	200.8±134.9	158.5±89.1	162.4±125.6	0.553
Graft material				0.692
Autogenous	11 (8.5%)	96 (73.8%)	107 (82.3%)
Allogenous	1 (0.8%)	22 (16.9%)	23 (17.7%)
Combined VP shunt				0.025
Yes	5 (3.8%)	16 (12.3%)	21 (16.2%)
No	7 (5.4%)	102 (78.5%)	109 (83.8%)

SD: standard deviation, VP: ventriculoperitoneal

TABLE 4.

Hematological factors for bone graft infection after cranioplasty

Variables	Infection (+) n=12	Infection (−) n=118	p-value
WBC±SD (×10⁹ cells/L)	9.15± 3.28	7.51± 2.97	0.078
ESR±SD (mm/hr)	24.83±24.36	29.87±33.11	0.360
CRP±SD (mg/dL)	0.38± 0.45	1.14± 5.29	0.894
Albumin±SD (g/dL)	4.00± 0.68	3.79± 0.54	0.353

SD: standard deviation, WBC: white blood cell, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein

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