Risk Factors for Reoperation after Traumatic Intracranial Hemorrhage

Abstract

Therefore, early identification and treatment is most important to improve neurological outcome. Though repeated computerized tomography (CT) scans and intracranial pressure (ICP) monitoring and serial neurological examinations are used for early identification, it is also important to identify the predictable risk factors above all.The goals of this study were to identify the risk factors for postoperative progression, and to compare the results with other previous reviews, and to prepare for neurological deterioration effectively. Materials and Methods Patient population and dataA retrospective review of 335 patients who experienced operation after TBI between 2001 and 2010 was performed. Of total 335 patients, we excluded 33 patients having operation due to simple or compound comminuted depressed fractures which were not combined with hematoma showing mass effect or requiring immediate evacuation. We also excluded the case which had been operated in other institute and transferred out to our hospital followed by secondary operation, due to the unavailability of initial data. In addition, we excluded the patients of initial Glasgow Coma Scale (GCS) below 4 or having multiple systemic trauma, due to the difficulty in evaluation of progression and the lack of viability.Among 302 patients except for those cases, 36 patients required reoperation due to hemorrhagic progression fol- Objective: Progression after operation in traumatic brain injury (TBI) is often correlated with morbidity and poor outcome. We have investigated to characterize the natural course of traumatic intracranial hemorrhage and to identify the risk factors for postoperative progression in TBI. Methods: 36 patients requiring reoperation due to hemorrhagic progression following surgery for traumatic intracranial hemorrhage were identified in a retrospective review of 335 patients treated at our hospital between 2001 and 2010. We reviewed the age, sex, Glasgow Coma Scale, the amount of hemorrhage, the type of hemorrhage, rebleeding site, coagulation profiles, and so on. Univariate statistics were used to examine the relationship between the risk factors and reoperation. Results: Acute subdural hematoma was the most common initial lesion requiring reoperation. Most patients had a reoperation within 24-48 hours after operation. Peri-lesional edema (p=0.002), and initial volume of hematoma (p=0.013) were the possible factors of hemorrhagic progression requiring reoperation. But preoperative coagulopathy was not risk factor of hemorrhagic progression requiring reoperation. Conclusion: Peri-lesional edema and initial volume of hematoma were the statistical significant factors requiring reoperation. Close observation with prompt management is needed to improve the outcome even in patient without coagulopathy. (Korean J Neurotrauma 2013;9:114-119) KEY WORDS: Traumatic brain injury ㆍRebleeding ㆍProgression ㆍRisk factor ㆍReoperation.