Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, USA; Department of Neurosurgery, Icahn School of Medicine, Mount Sinai Beth Israel, Mount Sinai Health System, USA.
Department of Neurologic Surgery, Mayo Clinic, USA.
J Clin Neurosci. 2020 May;75:35-39. doi: 10.1016/j.jocn.2020.03.042. Epub 2020 Mar 31.
Patients treated with craniotomy for subdural hematoma (SDH) evacuation have a higher readmission incidence when compared to other neurosurgical patients. Factors predictive of readmission following craniotomy for SDH are incompletely understood. The National Surgical Quality Improvement (NSQIP) database was queried for all patients treated by craniotomy for SDH of any etiology (e.g. acute, chronic, spontaneous, traumatic) during the study period (2012-2014). Patients requiring repeat hospitalization within 30 days of surgery were identified and classified by reason for readmission. Binary logistic regression analysis was used to identify predictors of readmission. 1024 patients met inclusion criteria, among whom 109 (10.6%) were readmitted within 30 days. The most common causes of readmission were recurrent SDH (n = 27; 33.3%), seizure (n = 8; 9.9%), new neurological deficit (n = 6; 7.4%), stroke (n = 6; 7.4%), and altered mental status (AMS) (n = 6; 7.4%). Multivariable modeling identified hypertension requiring medication (OR = 2.78, P = 0.013) and abnormal INR (OR = 2.66, P = 0.035) as significantly associated with readmission following chronic SDH, while postoperative UTI (OR = 3.64, P = 0.01) and stroke (OR = 4.86, P = 0.018) were significant predictors of readmission following acute SDH. Readmission was associated with recurrent hemorrhage after chronic/spontaneous SDH, while seizures, AMS, and neurological deficits drove readmissions after acute/traumatic SDH. Careful management of anticoagulation and antihypertensive medications may be helpful in reducing the risk of readmission following craniotomy for chronic SDH.
接受开颅手术治疗硬膜下血肿（SDH）清除术的患者与其他神经外科患者相比，再入院发生率更高。导致开颅术后 SDH 再入院的因素尚不完全清楚。本研究利用国家手术质量改进计划（NSQIP）数据库，对研究期间（2012-2014 年）因任何病因（如急性、慢性、自发性、外伤性）接受 SDH 开颅手术的所有患者进行了检索。确定了术后 30 天内再次住院的患者，并根据再入院原因进行分类。采用二项逻辑回归分析确定再入院的预测因素。共有 1024 例患者符合纳入标准，其中 109 例（10.6%）在 30 天内再次入院。再入院的最常见原因是复发性 SDH（n=27；33.3%）、癫痫发作（n=8；9.9%）、新发神经功能缺损（n=6；7.4%）、中风（n=6；7.4%）和意识状态改变（AMS）（n=6；7.4%）。多变量建模确定需要药物治疗的高血压（OR=2.78，P=0.013）和异常 INR（OR=2.66，P=0.035）与慢性 SDH 术后再入院显著相关，而术后尿路感染（OR=3.64，P=0.01）和中风（OR=4.86，P=0.018）是急性 SDH 术后再入院的显著预测因素。慢性/自发性 SDH 后再入院与复发性出血有关，而癫痫发作、AMS 和神经功能缺损是急性/外伤性 SDH 后再入院的原因。仔细管理抗凝和降压药物可能有助于降低慢性 SDH 开颅术后再入院的风险。
