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Reoperations after surgery for acute subdural hematoma: reasons, risk factors, and effects

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

To analyze the reasons and patient-related and injury-related risk factors for reoperation after surgery for acute subdural hematoma (SDH) and the effects of reoperation on treatment outcome.

Methods

Among adult patients operated on for acute SDH between 2013 and 2017, patients reoperated within 14 days after the primary surgery were identified. In all patients, parameters were identified that related to the patient (age, anticoagulation, antiplatelet, and antiepileptic treatment, and alcohol intoxication), trauma (Glasgow Coma Score, SDH thickness, midline shift, midline shift /hematoma thickness rate, other surgical lesion, primary surgery—trephination, craniotomy, or decompressive craniotomy), and Glasgow Outcome Score (GOS). The reasons for reoperation and intervals between primary surgery and reoperation were studied.

Results

Of 86 investigated patients, 24 patients were reoperated (27.9%), with a median interval of 2 days between primary surgery and reoperation. No significant differences in patients and injury-related factors were found between reoperated and non-reoperated patients. The rate of primary craniectomies was higher in non-reoperated patients (P = 0.066). The main indications for reoperation were recurrent /significant residual SDH (10 patients), contralateral SDH (5 patients), and expansive intracerebral hematoma or contusion (5 patients). The final median GOS was 3 in non-reoperated and 1.5 in reoperated patients, with good outcomes in 41.2% of non-reoperated and 16.7% of reoperated patients.

Conclusions

Reoperation after acute SDH surgery is associated with a significantly worse prognosis. Recurrent /significant residual SDH and contralateral SDH are the most frequently found reasons for reoperation. None of the analyzed parameters were significant reoperation predictors.

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Acknowledgements

The paper was not supported by any grant and received no funding.

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Authors and Affiliations

  1. Department of Neurosurgery, Faculty of Medicine, St. Anne’s Hospital Brno, Masaryk University, Pekařská 53, 656 91, Brno, Czech Republic

    Jan Chrastina, Čeněk Šilar, Tomáš Zeman, Barbora Musilová & Zdeněk Novák

  2. Institute of Biostatistics and Analyses, Masaryk University Medical Faculty, Brno, Czech Republic

    Michal Svoboda

  3. Faculty of Medicine, Institute of Forensic Medicine, Masaryk University, Brno, Czech Republic

    Jan Krajsa

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  1. Jan Chrastina
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  2. Čeněk Šilar
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  3. Tomáš Zeman
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Correspondence to Jan Chrastina.

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Chrastina, J., Šilar, Č., Zeman, T. et al. Reoperations after surgery for acute subdural hematoma: reasons, risk factors, and effects. Eur J Trauma Emerg Surg 46, 347–355 (2020). https://doi.org/10.1007/s00068-019-01077-6

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  • DOI: https://doi.org/10.1007/s00068-019-01077-6

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