Abstract | INTRODUCTION: METHODS: A single-institution retrospective case-control study was conducted from 2000 to 2015. Inclusion criteria were DC for acute supratentorial TICH ( subdural hemorrhage, epidural hemorrhage, and intraparenchymal hemorrhage) and ≥7 day survival. Patients underwent RS within 7 days of DC; controls did not require RS. Outcomes and predictors of RS were evaluated with univariate and multivariate logistic regression (MLR). RESULTS: Of 201 patients requiring DC, 28 (14%) underwent RS. Common mechanisms were ground-level fall (45%) and motor vehicle collision (29%). Anticoagulation/antiplatelet medication was used by 44 patients (21%). Subdural hemorrhage was the most common hemorrhage (64%). Using MLR, those requiring RS were more likely to experience major complications (odds ratio [OR], 22.6; 95% confidence interval [CI], 5.06-101.35; P < 0.001) and in-hospital mortality (OR, 2.76; 95% CI, 1.02-7.43; P = 0.045) and be dead/dependent at 6 months (OR, 2.50; 95% CI, 1.08-5.82; P = 0.033) and 2 years (OR, 2.44; 95% CI, 0.99-6.00; P = 0.051). Predictors of undergoing RS identified by MLR were smaller hemorrhage (OR, 0.32; 95% CI, 0.13-0.78; P = 0.012), larger midline shift (OR, 4.40; 95% CI, 1.43-13.51; P = 0.010), and better preoperative Glasgow Coma Scale score (OR, 1.28; 95% CI, 1.13-1.46; P < 0.001). CONCLUSIONS: Patients requiring RS after DC represent a heterogenous population with worse outcomes. Although the identified risk factors for RS are not modifiable, surgeons should be aware of these factors during the initial surgery.
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Authors | Matthews Lan, Robert J Dambrino 4th, Andrew Youssef, Aaron Yengo-Kahn, Michael C Dewan, Jesse Ehrenfeld, Christopher M Bonfield, Scott L Zuckerman |
Journal | World neurosurgery
(World Neurosurg)
Vol. 133
Pg. e757-e766
(Jan 2020)
ISSN: 1878-8769 [Electronic] United States |
PMID | 31604134
(Publication Type: Journal Article)
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Copyright | Copyright © 2019 Elsevier Inc. All rights reserved. |
Topics |
- Adult
- Aged
- Case-Control Studies
- Decompressive Craniectomy
- Female
- Humans
- Intracranial Hemorrhage, Traumatic
(pathology, surgery)
- Male
- Middle Aged
- Recurrence
- Reoperation
(statistics & numerical data)
- Retrospective Studies
- Risk Factors
- Treatment Outcome
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