Emergency Reoperations in Cranial Neurosurgery

Kwinta, Borys; Krzyżewski, Roger M.; Kliś, Kornelia M.; Donicz, Paulina; Gackowska, Małgorzata; Polak, Jarosław; Stachura, Krzysztof; Moskała, Marek

doi:10.1016/j.wneu.2017.06.090

Cited by 10 publications

(11 citation statements)

References 29 publications

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“…These patients are usually anemic [ 1 ]. A lower hemoglobin concentration is associated with a higher risk of reoperation [ 10 ], consistent with our findings, indirectly suggesting coagulation deficiency and poor nutrition. If hemorrhage is associated with severe anemia or severe hypotension, the mortality rate increases proportionately [ 16 ].…”

Section: Discussionsupporting

confidence: 90%

“…Emergency reoperation was defined as surgery performed due to a primary surgical condition [ 10 ]. The term “reoperation” refers to operations performed within two months of the primary operation and related to the initial surgery [ 2 ], although most commonly they were conducted much earlier [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The fact that six patients died from intracranial hemorrhage also suggests the importance of brain lesions in the increased risk of reoperation. Neurosurgical reoperations tend to be performed frequently following the initial operation [ 2 , 10 ]. Surgical complexity was reportedly associated with emergency reoperations [ 3 ], which was not shown in our findings.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors of emergency reoperations

et al. 2020

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Background: Emergency reoperation is considered to be a quality indicator in surgery. We analyzed the risk factors for emergency reoperations. Methods: Patients who underwent emergency operations from January 1, 2017, to December 31, 2017, at our hospital were reviewed in this retrospective study. Multivariate logistic regression was performed for the perioperative risk factors for emergency reoperation.Results: A total of 1,481 patients underwent emergency operations during the study period. Among them, 79 patients received emergency reoperations. The variables related to emergency reoperation included surgeries involving intracranial and intraoral lesions, highest mean arterial pressure ≥ 110 mmHg, highest heart rate ≥ 100 /min, anemia, duration of operation ＞120 min, and arrival from the intensive care unit (ICU). Conclusions: The type of surgery, hemodynamics, hemoglobin values, the duration of surgery, and arrival from ICU were associated with emergency reoperations.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk factors of emergency reoperations

et al. 2020

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“…The unplanned reoperation rate is comparable with other providers who report rates between 3.1% and 8.9%. [27][28][29] Similarly, nosocomial infection rates (7.4%) and surgical site infection rates (1.8%) were lower when compared with other published results. 30,31 The occurrence of any adverse event (14.5%) appears to be low; however, it is challenging to appropriately compare, as it is highly dependent on which events are included in this cumulative variable.…”

Section: Discussionmentioning

confidence: 55%

Development and validation of prediction scores for nosocomial infections, reoperations, and adverse events in the daily clinical setting of neurosurgical patients with cerebral and spinal tumors

Lohmann¹,

Brix

Varghese

et al. 2021

Journal of Neurosurgery

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OBJECTIVEVarious quality indicators are currently under investigation, aiming at measuring the quality of care in neurosurgery; however, the discipline currently lacks practical scoring systems for accurately assessing risk. The aim of this study was to develop three accurate, easy-to-use risk scoring systems for nosocomial infections, reoperations, and adverse events for patients with cerebral and spinal tumors.METHODSThe authors developed a semiautomatic registry with administrative and clinical data and included all patients with spinal or cerebral tumors treated between September 2017 and May 2019. Patients were further divided into development and validation cohorts. Multivariable logistic regression models were used to develop risk scores by assigning points based on β coefficients, and internal validation of the scores was performed.RESULTSIn total, 1000 patients were included. An unplanned 30-day reoperation was observed in 6.8% of patients. Nosocomial infections were documented in 7.4% of cases and any adverse event in 14.5%. The risk scores comprise variables such as emergency admission, nursing care level, ECOG performance status, and inflammatory markers on admission. Three scoring systems, NoInfECT for predicting the incidence of nosocomial infections (low risk, 1.8%; intermediate risk, 8.1%; and high risk, 26.0% [p < 0.001]), LEUCut for 30-day unplanned reoperations (low risk, 2.2%; intermediate risk, 6.8%; and high risk, 13.5% [p < 0.001]), and LINC for any adverse events (low risk, 7.6%; intermediate risk, 15.7%; and high risk, 49.5% [p < 0.001]), showed satisfactory discrimination between the different outcome groups in receiver operating characteristic curve analysis (AUC ≥ 0.7).CONCLUSIONSThe proposed risk scores allow efficient prediction of the likelihood of adverse events, to compare quality of care between different providers, and further provide guidance to surgeons on how to allocate preoperative care.

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“…2 CSF leaks and infections are potentially devastating complications that often result in hospitalization and can even lead to death. 2,[6][7][8]10,13 While infection and CSF leaks are responsible for the majority of reoperations following craniotomy, 7 pain and protrusion related to cranial plates and screws have been reported to prompt reoperation in 1.6% of cases. 5 Composed of a wet-field self-setting aqueous-based reaction comprising tetracalcium phosphate and phosphoserine, TTCP-PS is a novel, bioresorbable bone adhesive.…”

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confidence: 99%

Cranial flap fixation in sheep using a resorbable bone adhesive

Foley

Woodard

Slotkin

et al. 2021

Journal of Neurosurgery

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OBJECTIVEThe authors’ goal in this study was to investigate the use of a novel, bioresorbable, osteoconductive, wet-field mineral-organic bone adhesive composed of tetracalcium phosphate and phosphoserine (TTCP-PS) for cranial bone flap fixation and compare it with conventional low-profile titanium plates and self-drilling screws.METHODSAn ovine craniotomy surgical model was used to evaluate the safety and efficacy of TTCP-PS over 2 years. Bilateral cranial defects were created in 41 sheep and were replaced in their original position. The gaps (kerfs) were completely filled with TTCP-PS (T1 group), half-filled with TTCP-PS (T2 group), or left empty and the flaps fixated by plates and screws as a control (C group). At 12 weeks, 1 year, and 2 years following surgery, the extent of bone healing, local tissue effects, and remodeling of the TTCP-PS were analyzed using macroscopic observations and histopathological and histomorphometric analyses. Flap fixation strength was evaluated by biomechanical testing at 12 weeks and 1 year postoperatively.RESULTSNo adverse local tissue effects were observed in any group. At 12 weeks, the bone flap fixation strengths in test group 1 (1689 ± 574 N) and test group 2 (1611 ± 501 N) were both statistically greater (p = 0.01) than that in the control group (663 ± 385 N). From 12 weeks to 1 year, the bone flap fixation strengths increased significantly (p < 0.05) for all groups. At 1 year, the flap fixation strength in test group 1 (3240 ± 423 N) and test group 2 (3212 ± 662 N) were both statistically greater (p = 0.04 and p = 0.02, respectively) than that in the control group (2418 ± 1463 N); however, there was no statistically significant difference in the strengths when comparing the test groups at both timepoints. Test group 1 had the best overall performance based on histomorphometric evaluation and biomechanical testing. At 2 years postoperatively, the kerfs filled with TTCP-PS had histological evidence of osteoconduction and replacement of TTCP-PS by bone with nearly complete osteointegration.CONCLUSIONSTTCP-PS was demonstrated to be safe and effective for cranial flap fixation in an ovine model. In this study, the bioresorbable, osteoconductive bone adhesive appeared to have multiple advantages over standard plate-and-screw bone flap fixation, including biomechanical superiority, more complete and faster bony healing across the flap kerfs without fibrosis, and the minimization of bone flap and/or hardware migration and loosening. These properties of TTCP-PS may improve human cranial bone flap fixation and cranioplasty.

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Emergency Reoperations in Cranial Neurosurgery

Cited by 10 publications

References 29 publications

Risk factors of emergency reoperations

Risk factors of emergency reoperations

Development and validation of prediction scores for nosocomial infections, reoperations, and adverse events in the daily clinical setting of neurosurgical patients with cerebral and spinal tumors

Cranial flap fixation in sheep using a resorbable bone adhesive

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