Comparative Study of Computer-Aided Designed PEEK Implants Versus Autologous Bone Flap in Cranioplasty: Clinical Efficacy and Medical Economics Analysis.

Introduction: Cranial defects, often resulting from decompressive craniectomy, require timely repair to mitigate neurological risks and psychological sequelae. This study compares polyetheretherketone (PEEK) and autologous bone grafts in cranial reconstruction, focusing on clinical outcomes, cost-effectiveness, and utilization trends.

Methods: A retrospective analysis was conducted on the clinical data of 188 patients who underwent skull repair surgery in the neurosurgery department of the First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital) from June 1, 2015, to August 31, 2022. The patients were divided into a polyetheretherketone (PEEK) group (n=80) and an autogenous bone flap group (n=108) based on the different materials used for skull repair. Analyze the baseline data, repair materials, skull defect duration, hospitalization expenses, surgical information (duration of surgery, presence or absence of blood transfusion), and postoperative complications (epilepsy, hydrocephalus, subdural effusion, bone resorption, and infection) of the 2 groups of patients.

Results: There was no significant difference in baseline data, primary disease, and time of skull defect between the 2 groups of patients ( P >0.05). Comparison showed that traumatic brain injury (54.80%) was the main cause of skull repair surgery, followed by bleeding (22.30%) and cerebral infarction (18.10%). There was no significant difference in hospitalization time between the 2 groups of patients ( P >0.05), and there was no significant difference in the postoperative recovery of skull repair materials. However, the hospitalization cost of the PEEK group was higher than that of the autogenous bone group, and the difference was statistically significant ( P <0.05). The surgery time of PEEK group patients was shorter than that of the autogenous bone group, with PEEK 144 (109-185.75) minutes and autogenous bone 171.5 (155.25-187) minutes, respectively, and the difference was statistically significant ( P <0.05). In terms of postoperative complications, a total of 82 people experienced complications during the 3-month follow-up, including 19 people in the PEEK group (23.70%) and 63 people in the autogenous bone group (58.30%). There was no significant difference between the 2 groups in postoperative epilepsy, hydrocephalus, infection, etc. ( P >0.05). In terms of material selection for repairs, the use of PEEK has been on the rise year by year, and as the number of repair personnel tends to stabilize, the proportion of PEEK usage has been increasing year by year.

Conclusion: PEEK emerges as a cost-effective, clinically robust alternative to autologous bone grafts, particularly for complex defects. Policy interventions, including DRG-exempt payments and volume-based procurement, could further enhance its accessibility. These findings support broader adoption of PEEK in cranial reconstruction, balancing upfront costs with long-term clinical and economic benefits.