Emergency reoperations in cranial neurosurgery

• Published in: World neurosurgery Vol. 105; pp. 749 - 754
• Main Authors: Kwinta, Borys M., MD, PhD, Krzyżewski, Roger M., MD, Kliś, Kornelia M, Donicz, Paulina, Gackowska, Małgorzata, Polak, Jarosław, MD, PhD, Stachura, Krzysztof, MD, PhD, Moskała, Marek, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: Adult; Aged; Brain Injuries, Traumatic - diagnosis; Brain Injuries, Traumatic - epidemiology; Brain Injuries, Traumatic - surgery; Brain Neoplasms - diagnosis; Brain Neoplasms - epidemiology; Brain Neoplasms - surgery; Complications; Craniotomy - methods; Craniotomy - trends; Emergency Treatment - methods; Emergency Treatment - trends; Female; Frontal craniotomy; Humans; Male; Middle Aged; Neurosurgery; Neurosurgical Procedures - methods; Neurosurgical Procedures - trends; Reoperation - methods; Reoperation - trends; Reoperations; Retrospective Studies; Second-Look Surgery - methods; Second-Look Surgery - trends; OR; Complications; CI; Cerebrospinal Fluid; Mean Cell Haemoglobin Concentration; Standard Deviation; Frontal craniotomy; SD; Confidence Interval; MCHC; CSF; Odds Ratio; Reoperations
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.06.090

Abstract Background Complications after neurosurgical procedures which lead to reoperation are associated with poor outcome and economic costs. Therefore the aim of our study was to establish predictors of reoperation due to complications after cranial neurosurgery. Methods We retrospectively analysed 875 patients who underwent a cranial neurosurgical procedure. We used univariate and multivariate logistic regression analysis to determine the possible predictors of reoperation. Results A total of 78 (8.91%) patients underwent emergency reoperation. Those patients more often were operated due to brain tumour (50.65% vs.38.43%; p=0.036) and least often due to head trauma (22.08% vs. 32.99%; p=0.049). Reoperated patients more often underwent frontal craniotomy (26.47% vs. 13.46%; p < 0.01) and least often had burr hole surgery (7.35% vs. 19.21%; p=0.016). Patients who did not require reoperation were more often operated during weekend (5.29% vs. 16.99%; p < 0.01). After adjustment for confounders weekend surgeries (OR: 0.309; 95% CI: 0.111 – 0.861; p = 0.025) remained independently associated with reduced risk of reoperation and frontal craniotomy (OR: 1.355; 95% CI: 1.005 – 1.354; p = 0.046) and lower MCHC (OR: 2.227; 95% CI: 1.230 – 4.033; p < 0.01) remained independently associated with higher risk of reoperation. Conclusions Brain tumour surgery and frontal craniotomy are associated with higher risk of emergency reoperation. Patients with head trauma, operated during weekend and those who underwent burr hole surgery are less likely to be reoperated. Frontal craniotomy and lower MCHC are independently associated with higher risk of reoperation and operation during weekend with lower risk of reoperation .