Factors associated with infection-related failure in autologous cranioplasty for traumatic brain injury: a matched case-control study in Vietnam

This study aimed to identify associated factors of infection-related failure in autologous cranioplasty for traumatic brain injury in Vietnam. 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 two 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. 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 30-90 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 cm 2 ) (OR: 4.32, 95% CI: 1.54 – 12.15). 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.