Incidence and risk factors of early postoperative complications in patients after decompressive craniectomy: a 5-year experience

• Published in: European journal of trauma and emergency surgery (Munich : 2007) Vol. 47; no. 5; pp. 1635 - 1647
• Main Authors: Hanko, Martin, Soršák, Jakub, Snopko, Pavol, Opšenák, René, Zeleňák, Kamil, Kolarovszki, Branislav
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2021; Springer Nature B.V
• Subjects: Body fluids; Convulsions & seizures; Critical Care Medicine; Emergency medical care; Emergency Medicine; Health risks; Hematoma; Intensive; Medicine; Medicine & Public Health; Meningitis; Neurosurgery; Original Article; Postoperative period; Risk factors; Sports Medicine; Surgery; Surgical Orthopedics; Traumatic Surgery; Reoperation; Decompressive craniectomy; Complications; Risk factors
• ISSN: 1863-9933; 1863-9941
• DOI: 10.1007/s00068-020-01367-4

Purpose Decompressive craniectomy is an effective measure to reduce a pathologically elevated intracranial pressure. Patients’ survival and life quality following this surgery have been a subject of several studies and significantly differ according to the primary diagnosis. Since this operation is often associated with a wide spectrum of possibly serious complications, we aimed to describe their incidence and possible associated risk factors. Methods We evaluated 118 patients who underwent decompressive craniectomy at our clinic during years 2013–2017. The indications included traumatic brain injuries, ischaemic or haemorrhagic strokes and postoperative complications of planned neurosurgical procedures. Subsequently, we assessed the incidence of early postoperative complications (occurring during the first 3 postoperative weeks). The results were statistically analysed with relation to a wide selection of possible risk factors. Results At least one early surgical postoperative complication occurred in 87 (73.73%) patients, the most frequent being a development of an extraaxial fluid collection in 41 (34.75%) patients. We were able to identify risk factors linked with extraaxial fluid collections, subcutaneous and extradural haematomas, postoperative seizures and meningitis. An overall need for reoperation was 13.56%. Neither the duration of the surgery nor the qualification of the operating surgeon had any effect on the complications’ occurrence. Conclusions Decompressive craniectomy is associated with numerous early postoperative complications with a various degree of severity. Most cases of complications can, however, be managed in a conservative way. The risk factors linked with postoperative complications should be taken into account during the indication process in each individual patient.