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European Journal of Trauma and Emergency Surgery

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01-04-2020 | Subdural Hematoma | Original Article

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

Authors: Jan Chrastina, Čeněk Šilar, Tomáš Zeman, Michal Svoboda, Jan Krajsa, Barbora Musilová, Zdeněk Novák

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2020

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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Title: Reoperations after surgery for acute subdural hematoma: reasons, risk factors, and effects
Authors: Jan Chrastina
Čeněk Šilar
Tomáš Zeman
Michal Svoboda
Jan Krajsa
Barbora Musilová
Zdeněk Novák
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Keywords: Subdural Hematoma
Craniotomy
Hematoma
Intracerebral Hematoma
Published in: European Journal of Trauma and Emergency Surgery / Issue 2/2020
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-019-01077-6

ACC 2024 Congress

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

ACC 2024 Congress

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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