Comparison of Perioperative and Long-term Outcomes Following PEEK and Autologous Cranioplasty: A Single Institution Experience and Review of the Literature

Abstract

Three-dimensionally (3D) printed polyether-ether-ketone (PEEK) implants are a relatively novel option for cranioplasty that have recently gained popularity. However, there is ongoing debate with respect to material efficacy and safety compared to autologous bone grafts. The purpose of this study was to offer our institution's experience and add to the growing body of literature. A single-institution retrospective analysis of patients undergoing cranioplasties between 2016 and 2021. Patients were divided into PEEK and autologous cranioplasty cohorts. Parameters of interest included patient demographics as well as perioperative (<3 months postoperative) and long-term outcomes (>3 months postoperative). A P value < 0.05 was considered statistically significant. A total of 31 patients met inclusion criteria (PEEK: 15, Autologous: 16). Mean age of total cohort was 48.9 years (range 19-82 years). Modified Frailty Index (mFI) revealed greater rate of comorbidities among the Autologous group (P= 0.073), which was accounted for in statistical analyses. Multiple logistic regression model revealed significantly higher rate of surgical site infection in the Autologous cohort (31.3% vs. 0%, P= 0.011). Minor complications were similar between groups, while the Autologous group experienced significantly more major postoperative complications (50%) versus PEEK (13.3%) (P= 0.0291). Otherwise perioperative and long term complication profiles were similar between groups. Additionally, generalized linear model demonstrated both cohorts had similar mean hospital length of stay (LoS) (Autologous: 16.1 vs. PEEK: 10.7 days). PEEK cranioplasty implants may offer more favorable perioperative complication profiles with similar long-term complication rates and hospital LoS compared to autologous bone implants. Future studies are warranted to confirm our findings in larger series, and further examine the utility of PEEK in cranioplasty.