Risk factors for recurrent hematomas after surgery for acute traumatic subdural hematoma.

: Heino Iiro, Frantzén Janek, Rinne Jaakko, Girard Romuald, Cao Ying, Sajanti Antti, Katila Ari J., Posti Jussi P., Takala Riikka S.K., Tenovuo Olli, Koskimäki Janne

Publisher: ELSEVIER SCIENCE INC

: 2019

: World Neurosurgery

: World Neurosurg

: 124

: e563

: e571

: 9

: 1878-8750

: 1878-8769

DOI: https://doi.org/10.1016/j.wneu.2018.12.155

OBJECTIVE: The development of postcraniotomy hematoma (PCH) after surgery for acute traumatic subdural hematoma (aSDH) has been associated with increased risk for poor outcome. The risk factors contributing to PCH remain poorly understood. Our aim was to study potential risk factors for PCH in a consecutive series of surgically evacuated patients with aSDH.
METHODS: 132 patients with aSDH operated at Turku University Hospital, Turku, Finland, between 2008-2012 were enrolled in this retrospective cohort study. The demographic, clinical, laboratory and imaging data were collected from the medical records. A comprehensive analysis of the data using six different univariate methods including machine learning and multivariate analyses was conducted to identify factors related to PCH.
RESULTS: The incidence of PCH after a primary surgery for traumatic aSDH was 10.6%. Patients suffering fro PCH were younger (p = 0.04). There was no difference in the use of anticoagulant or antiplatelet medication between patients with and without PCH. Multivariate analyses identified alcohol inebriation at the time of injury (OR 12.67, p = 0.041) and hypocapnia (OR 26.09, p = 0.003) as independent risk factors for PCH. The patients with PCH had less often hyponatremia (OR 0.08, p = 0.018) and their maximal systolic blood pressures were lower (OR 0.94, p = 0.009). The AUC for the multivariate model was 0.96 (p = 0.049) with a Youden index of J = 0.88.
CONCLUSIONS: The results suggest that alcohol inebriation at the time of injury and hypocapnia during hospitalization are risk factors for the development of PCH.