Citation

Heino I, Frantzén J, Rinne J, Girard R, Cao Y, Sajanti A, Katila AJ, Posti JP, Takala RSK, Tenovuo O, Koskimäki J. World Neurosurg. 2019; ePub(ePub): ePub.

Affiliation

Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital and University of Turku, Turku, Finland; Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine and Biological Sciences, Chicago, Illinois, US. Electronic address: koskimaki@uchicago.edu.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.wneu.2018.12.155

PMID

30639489

Abstract

OBJECTIVE: The development of postcraniotomy hematoma (PCH) after surgery for acute traumatic subdural hematoma (aSDH) has been associated with increased risk for poor outcome. The risk factors contributing to PCH remain poorly understood. Our aim was to study potential risk factors for PCH in a consecutive series of surgically evacuated patients with aSDH.

METHODS: 132 patients with aSDH operated at Turku University Hospital, Turku, Finland, between 2008-2012 were enrolled in this retrospective cohort study. The demographic, clinical, laboratory and imaging data were collected from the medical records. A comprehensive analysis of the data using six different univariate methods including machine learning and multivariate analyses was conducted to identify factors related to PCH.

RESULTS: The incidence of PCH after a primary surgery for traumatic aSDH was 10.6%. Patients suffering from PCH were younger (p = 0.04). There was no difference in the use of anticoagulant or antiplatelet medication between patients with and without PCH. Multivariate analyses identified alcohol inebriation at the time of injury (OR 12.67, p = 0.041) and hypocapnia (OR 26.09, p = 0.003) as independent risk factors for PCH. The patients with PCH had less often hyponatremia (OR 0.08, p = 0.018) and their maximal systolic blood pressures were lower (OR 0.94, p = 0.009). The AUC for the multivariate model was 0.96 (p = 0.049) with a Youden index of J = 0.88.

CONCLUSIONS: The results suggest that alcohol inebriation at the time of injury and hypocapnia during hospitalization are risk factors for the development of PCH.

Copyright © 2019 Elsevier Inc. All rights reserved.

Language: en

Keywords

Acute subdural hematoma; Multivariate analysis; Postcraniotomy hematoma; Risk factor; Surgery; Traumatic brain injury