Department of Neurosurgery, Faculty of Medicine, St. Anne's Hospital Brno, Masaryk University, Pekařská 53, 656 91, Brno, Czech Republic.
Institute of Biostatistics and Analyses, Masaryk University Medical Faculty, Brno, Czech Republic.
Eur J Trauma Emerg Surg. 2020 Apr;46(2):347-355. doi: 10.1007/s00068-019-01077-6. Epub 2019 Jan 23.
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.
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.
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.
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.
分析急性硬膜下血肿（SDH）手术后再次手术的原因及与患者和损伤相关的危险因素，以及再次手术对治疗结果的影响。
在 2013 年至 2017 年间接受急性 SDH 手术的成年患者中，确定了在初次手术后 14 天内再次手术的患者。对所有患者，确定了与患者（年龄、抗凝、抗血小板和抗癫痫治疗以及酒精中毒）、创伤（格拉斯哥昏迷评分、SDH 厚度、中线移位、中线移位/血肿厚度比、其他手术损伤、初次手术-颅骨钻孔、开颅或减压性开颅术）和格拉斯哥结局评分（GOS）相关的参数。研究了再次手术的原因和初次手术与再次手术之间的间隔。
在 86 例研究患者中，有 24 例患者再次手术（27.9%），初次手术与再次手术之间的中位数间隔为 2 天。再次手术患者和损伤相关因素与未再次手术患者无显著差异。未再次手术患者的原发性开颅术率较高（P=0.066）。再次手术的主要指征是复发性/明显残留的 SDH（10 例）、对侧 SDH（5 例）和扩张性颅内血肿或挫裂伤（5 例）。未再次手术患者的最终中位 GOS 为 3，再次手术患者为 1.5，未再次手术患者中有 41.2%预后良好，再次手术患者中有 16.7%预后良好。
急性 SDH 手术后再次手术与预后显著恶化相关。复发性/明显残留的 SDH 和对侧 SDH 是再次手术最常见的原因。分析的参数均不是再次手术的显著预测因素。
