Medical Student University of Utah School of Medicine Salt Lake City, Utah, United States
Introduction: Despite higher rates of failure and revision, autologous bone implants are the historical gold standard for restoring cranial defects following decompressive hemicraniectomy. More reliable synthetic implants have been developed, though they carry significantly higher upfront costs. We sought to assess whether the inflated initial cost of non-autologous implants is economically justified by reducing the necessity of retreatment, more commonly observed among autologous implants.
Methods: Using our hospital’s billing records from 2011-2022, cases that required cranioplasty following decompressive hemicraniectomy for trauma or stroke were identified. The inpatient costs for cranioplasty imaging, supply, implants, pharmacy, facility, labs, and total direct costs were collected. Univariate and multivariate analyses compared the clinical characteristics, long-term outcomes, and economic effectiveness of autologous vs. non-autologous implants.
Results: 119 autologous and 27 non-autologous implants were analyzed. Compared to those with autologous implants, patients with non-autologous implants were significantly younger (32.8 vs. 41.8 years, p=0.005), had longer intervals from hemicraniectomy to cranioplasty (119 vs. 61 days, p=0.001), were more often due to trauma than stroke (96% vs. 70%, p=0.004), and had smaller graft sizes (137 vs. 152 cm, p=0.012). Failure rates between non-autologous vs. autologous grafts were insignificant (14.8% non-autologous vs. 22.7% autologous, p=0.366). Regarding initial costs, despite non-autologous implants being significantly more expensive ($11,972 vs. $3,601, p< 0.001), total first cranioplasty costs were nearly identical ($29,312 vs. $28,211, p=0.901). With first and subsequent revision cranioplasty costs totaled, cost differences between the treatments remained insignificant ($32,167 vs. $34,043, p=0.843). Linear regression found higher Glasgow Coma Score at hemicraniectomy and longer hemicraniectomy to cranioplasty interval to be significantly associated with lower initial cranioplasty costs and lower total cranioplasty treatment costs (p=0.024 and 0.006, respectively).
Conclusion : Considering the cost of non-autologous implants are similar to autologous implants in both the short- and long-term, they could be utilized as a primary therapeutic intervention.
