title: Which One Is Better to Reduce the Infection Rate, Early or Late Cranioplasty?
abstract: OBJECTIVE
  Decompressive craniectomy is an effective therapy to relieve high intracranial pressure after acute brain damage. However, the optimal timing for cranioplasty after decompression is still controversial. Many authors reported that early cranioplasty may contribute to improve the cerebral blood flow and brain metabolism. However, despite all the advantages, there always remains a concern that early cranioplasty may increase the chance of infection. The purpose of this retrospective study is to investigate whether the early cranioplasty increase the infection rate. We also evaluated the risk factors of infection following cranioplasty.
  
  
  METHODS
  We retrospectively examined the results of 131 patients who underwent cranioplasty in our institution between January 2008 and June 2015. We divided them into early (≤90 days) and late (>90 days after craniectomy) groups. We examined the risk factors of infection after cranioplasty. We analyzed the infection rate between two groups.
  
  
  RESULTS
  There were more male patients (62%) than female (38%). The mean age was 49 years. Infection occurred in 17 patients (13%) after cranioplasty. The infection rate of early cranioplasty was lower than that of late cranioplasty (7% vs. 20%; p=0.02). Early cranioplasty, non-metal allograft materials, re-operation before cranioplasty and younger age were the significant factors in the infection rate after cranioplasty (p<0.05). Especially allograft was a significant risk factor of infection (odds ratio, 12.4; 95% confidence interval, 3.24-47.33; p<0.01). Younger age was also a significant risk factor of infection after cranioplasty by multivariable analysis (odds ratio, 0.96; 95% confidence interval, 0.96-0.99; p=0.02).
  
  
  CONCLUSIONS
  Early cranioplasty did not increase the infection rate in this study. The use of non-metal allograft materials influenced a more important role in infection in cranioplasty. Actually, timing itself was not a significant risk factor in multivariate analysis. So the early cranioplasty may bring better outcomes in cognitive functions or wound without raising the infection rate.
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
authors.forename: Jae-Sang
authors.initials: JS
authors.lastname: Oh
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
authors.forename: Kyeong-Seok
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
authors.forename: Jai-Joon
authors.initials: JJ
authors.lastname: Shim
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
authors.forename: Seok-Mann
authors.initials: SM
authors.lastname: Yoon
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Doh
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
authors.forename: Hack-Gun
authors.initials: HG
authors.lastname: Bae
keywords: Cranioplasty; Decompressive craniectomy; Hydroxyapatities; Infection