Incidence of Postoperative Hematomas Requiring Surgical Treatment in Neurosurgery : A Retrospective Observational Study

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Lillemae , K , Jarvio , J A , Silvasti-Lundell , M K , Antinheimo , J J-P , Hernesniemi , J A & Niemi , T T 2017 , ' Incidence of Postoperative Hematomas Requiring Surgical Treatment in Neurosurgery : A Retrospective Observational Study ' , World Neurosurgery , vol. 108 , pp. 491-497 . https://doi.org/10.1016/j.wneu.2017.09.007

Title: Incidence of Postoperative Hematomas Requiring Surgical Treatment in Neurosurgery : A Retrospective Observational Study
Author: Lillemae, Kadri; Jarvio, Johanna Annika; Silvasti-Lundell, Marja Kaarina; Antinheimo, Jussi Juha-Pekka; Hernesniemi, Juha Antero; Niemi, Tomi Tapio
Contributor: University of Helsinki, Department of Surgery
University of Helsinki, Neurokirurgian yksikkö
University of Helsinki, Neurokirurgian yksikkö
University of Helsinki, Clinicum
Date: 2017-12
Language: eng
Number of pages: 7
Belongs to series: World Neurosurgery
ISSN: 1878-8750
URI: http://hdl.handle.net/10138/298142
Abstract: OBJECTIVE: We aimed to characterize the occurrence of postoperative hematoma (POH) after neurosurgery overall and according to procedure type and describe the prevalence of possible confounders. METHODS: Patient data between 2010 and 2012 at the Department of Neurosurgery in Helsinki University Hospital were retrospectively analyzed. A data search was performed according to the type of surgery including craniotomies; shunt procedures, spine surgery, and spinal cord stimulator implantation. We analyzed basic preoperative characteristics, as well as data about the initial intervention, perioperative period, revision operation and neurologic recovery (after craniotomy only). RESULTS: The overall incidence of POH requiring reoperation was 0.6% (n = 56/8783) to 0.6% (n = 26/4726) after craniotomy, 0% (n = 0/928) after shunting procedure, 1.1% (n = 30/2870) after spine surgery, and 0% (n = 0/259) after implantation of a spinal cord stimulator. Craniotomy types with higher POH incidence were decompressive craniectomy (7.9%, n = 7/89), cranioplasty (3.6%, n = 4/112), bypass surgery (1.7%, n = 1/60), and epidural hematoma evacuation (1.6%, n = 1/64). After spinal surgery, POH was observed in 1.1% of cervical and 2.1% of thoracolumbar operations, whereas 46.7% were multilevel procedures. 64.3% of patients with POH and 84.6% of patients undergoing craniotomy had postoperative hypertension (systolic blood pressure >160 mm Hg or lower if indicated). Poor outcome (Glasgow Outcome Scale score 1-3), whereas death at 6 months after craniotomy was detected in 40.9% and 21.7%. respectively, of patients with POH who underwent craniotomy. CONCLUSIONS: POH after neurosurgery was rare in this series but was associated with poor outcome. Identification of risk factors of bleeding, and avoiding them, if possible, might decrease the incidence of POH.
Subject: Delayed postoperative spinal epidural hematoma
Neurosurgery
POH
Postoperative hematoma
SEH
Spinal epidural hematoma
Spinal surgery
SPINAL EPIDURAL HEMATOMA
AVOIDABLE RISK-FACTORS
DECOMPRESSIVE CRANIECTOMY
INTRACRANIAL HEMATOMA
CLINICAL ARTICLE
VENOUS THROMBOEMBOLISM
EARLY CRANIOPLASTY
HEAD-INJURY
SURGERY
COMPLICATIONS
3112 Neurosciences
3124 Neurology and psychiatry
3126 Surgery, anesthesiology, intensive care, radiology
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