微创钻孔密闭引流手术治疗慢性硬膜下血肿临床疗效观察

目的探讨观察微创钻孔密闭引流技术在慢性硬膜下血肿治疗中的应用价值。方法按入选标准及课题研究方案选取124例CSDH患者,随机分为A组(单孔钻孔引流)和B组(双孔钻孔密闭引流),分别统计分析两组手术、拔管、留院时间,气颅、血肿复发率、神经康复等指标。结果⑴与B组相比,A组的患者在手术时间、住院时间相比明显少(P0.01);⑵与B组相比,A组的患者气颅发生率较少(P0.05),两组在血肿复发率无统计学差异(P0.05)。⑶与B组相比,A组患者神经康复指标BI和GOS较低(P0.01)。结论⑴微创钻孔密闭引流术(单、双孔)是治疗CSDH的行之有效的方法,⑵单孔密闭引流术在手术及留院时间、气颅发生率方面具有优势,而在3个月神经康复方面双孔引流较好。     

Two surgical methods used in 90 patients with intracranial subdural empyema

We studied the efficacy of two surgical methods used for the treatment of intracranial subdural empyema (ISDE) at our centre. A cross-sectional study (1999–2005) of 90 patients with non-traumatic supratentorial ISDE revealed that the two surgical methods used for empyema removal were burr hole/s and drainage (50 patients, 55.6%) and a cranial bone opening procedure (CBOP) (40 patients, 44.4%). Patients in the CBOP group had a better result in terms of clinical improvement (chi-squared analysis, p = 0.006) and clearance of empyema on brain CT scan (chi-squared analysis, p < 0.001). Reoperation was more frequent among patients who had undergone burr hole surgery (multiple logistic regression, p < 0.001). The outcome and morbidity of ISDE survivors were not related to the surgical method used (p > 0.05). The only factor that significantly affected the morbidity of ISDE was level of consciousness at the time of surgery (multiple logistic regression, p < 0.001). We conclude that CBOP and evacuation of the empyema is a better surgical method for ISDE than burr hole/s and drainage. Wide cranial opening and empyema evacuation improves neurological status, gives better clearance of the empyema and reduces the need for reoperation. Level of consciousness at the time of presentation is a predictor of the morbidity of ISDE. Thus, aggressive surgical treatment should occur as early as possible, before the patient deteriorates.     

单、双颅骨钻孔治疗慢性硬膜下血肿201例效果比较

目的分析颅骨钻孔数量对治疗慢件硬膜下血肿效果的影响。方法20l例慢性硬膜下血肿患者按单、双颅骨钻孔分为两组，以是否须再次手术为标准，比较两者间疗效的差异结果颅骨钻孔数量不影响治疗效果。结论该部位血肿的手术治疗颅骨钻单孔即可。     

Influence of antithrombotic agents on the recurrence of chronic subdural hematomas and the quest about the recommencement of antithrombotic agents: A meta-analysis

Antithrombotic agents (AT), including anticoagulants and antiplatelets, are risk factors of chronic subdural hematomas (CSDHs). However, the use of AT has not been clearly associated with postoperative recurrence (PR) in the literature before. Furthermore, the association between the resumption of AT and postoperative complications also requests research. Databases including Pubmed, Embase and Cochrane were searched for patients presenting with CSDH on anticoagulant or antiplatelet medication. Ten studies were included to analyze the association between the use of AT and PR: The meta-analysis showed that the use of AT, both anticoagulants (OR = 2.20, 95%CI [1.45, 3.33]; P = 0.0002) and antiplatelets (OR = 1.64, 95%CI [1.17, 2.30]; P = 0.004), could increase the PR rate. Two studies were included to analyze the relationship between the resumption of AT and postoperative complications. The meta-analysis showed that after the patients on AT resumed their medication, the risk of PR did not increase (OR = 0.33, 95%Cl [0.13, 0.80]; P = 0.01), and the occurrence of thromboembolism events had no statistical significance (OR = 1.30, 95%CI [0.26, 6.50]; P = 0.75). This meta-analysis demonstrated that AT were risk factors for the recurrence of CSDH. Recommencement of AT did not appear to increase the risk of postoperative hemorrhage, and could reduce the risk of thromboembolism. Thus, appropriate postoperative resumption of anticoagulants or antiplatelets may be safe. Still, more evidence is needed to answer the question about whether and how to resume AT.     

Perfusion CT investigation of chronic internal carotid artery occlusion: comparison with SPECT

This study investigated the usefulness of perfusion computed tomography (CT) for the evaluation of patients with chronic internal carotid artery (ICA) occlusion by comparing the findings with those of iodine-123 iodoamphetamine ([¹²³I]IMP) single photon emission computed tomography (SPECT). Twenty five patients with chronic ICA occlusion were investigated on the same day by perfusion CT to measure the cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transient time (MTT), and [¹²³I]IMP SPECT to measure the regional CBF, significant correlations were observed between regional CBF measured by SPECT and CBF measured by perfusion CT (r = 0.659, R² = 0.434, p < 0.001), regional CBF and CBV (r = −0.406, R² = 0.165, p < 0.001) and regional CBF and MTT (r = −0.592, R² = 0.350, p < 0.001). Significant correlations were also observed between CBF and CBV (r = −0.153, R² = 0.023, p < 0.001), CBF and MTT (r = −0.580, R² = 0.337, p < 0.001) and MTT and CBV (r = 0.763, R² = 0.582, p < 0.001). Perfusion CT is useful to evaluate the hemodynamic state of patients with chronic major cerebral artery occlusive disorders.     

Traumatic interhemispheric subdural haematoma: Study of 35 cases

The clinical and radiological findings, management, and outcomes in 35 patients with traumatic interhemispheric subdural haematoma (ISH) were reviewed retrospectively. Twenty-five patients had favourable outcomes and 10 had poor outcomes. All patients were treated conservatively for ISH. Univariate analysis found that the Glasgow Coma Scale (GCS) score (p < 0.001), hypovolemic shock (p = 0.018), skull fracture (p = 0.008), convexity or posterior fossa subdural haematoma (p = 0.008), and subarachnoid haemorrhage (SAH) were correlated with outcome (p < 0.001). Multivariate analysis showed that GCS score (p = 0.031; odds ratio [OR], 0.6; 95% confidence interval [CI], 0.3–0.9) and the presence of SAH (p = 0.023; OR, 14.2; 95% CI, 1.5–138.2) were significantly related to poor outcome. This study provides important information on the clinicoradiological findings and prognoses in patients with traumatic ISH.     

Early screening and identification of psychological comorbidities in pediatric epilepsy is necessary

Youth with epilepsy often have co-occurring psychological symptoms that are due to underlying brain pathology, seizures, and/or antiepileptic drug side effects. The primary study aim was to compare the psychological comorbidities of youth with new-onset epilepsy versus chronic epilepsy. Primary caregivers of youth with either new-onset (n = 82; M_age = 9.9 ± 2.9) or chronic epilepsy (n = 76; M_age = 12.8 ± 3.3) completed the Behavioral Assessment Scale for Children—2nd Edition. Compared to those with new-onset epilepsy, the chronic group had significantly higher depressive and withdrawal symptoms, as well as lower activities of daily living. A higher proportion of youth with chronic epilepsy exhibited at-risk/clinically elevated depressive symptoms and difficulties with activities of daily living compared to the new-onset group. Proactive screening in youth with epilepsy to ensure timely identification of psychological symptoms and to guide early psychological intervention is warranted.     

Perioperative complications in open versus percutaneous treatment of spinal fractures in patients with an ankylosed spine

We compared open stabilization of vertebral fractures to percutaneous spinal fixation techniques in patients with a diagnosis of either ankylosing spondylitis (AS) or diffuse idiopathic skeletal hyperostosis (DISH). A retrospective review of patients known to have AS or DISH treated for spinal column fracture at a single institution between 1995 and 2011 was performed. Patients were analyzed by the type of fixation, divided into either a percutaneous group (PG) or an open group (OG). There were 41 patients identified with a spinal column fracture and history of AS or DISH who received surgical intervention. There were 17 (42%) patients with AS and 24 (58%) with DISH. Patients in the PG and OG cohorts presented with similar mechanisms of injury, Injury Severity Scale, number of vertebral fractures, number of additional injuries, and Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification scores. Mean operative time (254.76 minutes versus 334.67 minutes, p = 0.040), estimated blood loss (166.8 versus 1240.36 mL, p < 0.001), blood transfusion volume (178.32 versus 848.69 mL, p < 0.001), and time to discharge (9.58 days versus 16.73 days, p = 0.008) were significantly less in the PG cohort. The rate of blood transfusion (36% versus 87.5%, p = 0.001) and complications (56% versus 87%, p = 0.045) were significantly less in the PG cohort. Percutaneous stabilization of fractures in patients with AS or DISH was associated with lower blood loss, shorter operative times and decreased need for transfusion, shorter hospitalization time and a lower perioperative complication rate.     

Reversal of warfarin associated coagulopathy with 4-factor prothrombin complex concentrate in traumatic brain injury and intracranial hemorrhage

Warfarin-associated intracranial hemorrhage is associated with a high mortality rate. Ongoing coagulopathy increases the likelihood of hematoma expansion and can result in catastrophic hemorrhage if surgery is performed without reversal. The current standard of care for emergency reversal of warfarin is with fresh frozen plasma (FFP). In April 2013, the USA Food and Drug Administration approved a new reversal agent, 4-factor prothrombin complex concentrate (PCC), which has the potential to more rapidly correct coagulopathy. We sought to determine the feasibility and outcomes of using PCC for neurosurgical patients. A prospective, observational study of all patients undergoing coagulopathy reversal for intracranial hemorrhage from April 2013 to December 2013 at a single, tertiary care center was undertaken. Thirty three patients underwent emergent reversal of coagulopathy using either FFP or PCC at the discretion of the treating physician. Intracranial hemorrhage included subdural hematoma, intraparenchymal hematoma, and subarachnoid hemorrhage. FFP was used in 28 patients and PCC was used in five patients. International normalized ratio at presentation was similar between groups (FFP 2.9, PCC 3.1, p = 0.89). The time to reversal was significantly shorter in the PCC group (FFP 256 minutes, PCC 65 minutes, p < 0.05). When operations were performed, the time delay to perform operations was also significantly shorter in the PCC group (FFP 307 minutes, PCC 159 minutes, p < 0.05). In this preliminary experience, PCC appears to provide a rapid reversal of coagulopathy. Normalization of coagulation parameters may prevent further intracranial hematoma expansion and facilitate rapid surgical evacuation, thereby improving neurological outcomes.     

Sensitivity of neurovascular ultrasound for the detection of spontaneous cervical artery dissection

The reported sensitivity of neurovascular ultrasound (nUS) for detecting spontaneous cervical artery dissection (sCAD) varies from 80% to 96% in the internal carotid artery (ICA) and from 70% to 86% in the vertebral arteries (VA). The aim of this study was to assess the sensitivity of nUS compared to MRI of the neck and MR angiography for the detection of sCAD. Forty consecutive patients with sCAD proven by 1.5 T MRI were investigated by nUS within 48 hours of admission. A total of 52 cases of sCAD were detected by MRI, equally distributed (n = 26, 50%) in the ICA and VA territories. Two sCADs affecting the ICA (n = 2, 8%) and two sCADs of the VA (n = 2, 8%) had normal initial nUS findings. The sensitivity of nUS in detecting sCAD is high, about 92% for both vascular territories. However, intramural hematomas may be missed either when they are located outside the arterial segments directly visible by nUS or if they are too small to cause hemodynamically significant stenosis.     

Lymphocyte infiltration of neocortex and hippocampus after a single brief seizure in mice

Various immune responses have been described in epileptic patients and animal models of epilepsy, but immune responses in brain after a single seizure are poorly understood. We studied immune responses in brain after a single brief generalized tonic–clonic seizure in mice. C57bl/6 mice, either unanesthetized or anesthetized (pentobarbital, ethyl chloride) received either electrical (15–30 mA, 100 Hz, 1 s) or sham stimulation (subcutaneous electrodes over frontal lobe, no current). Electrical stimulation of unanesthetized mice resulted in tonic–clonic convulsions with hind-limb extension (maximal seizure), tonic–clonic convulsions without hind-limb extension (submaximal seizure), or no seizure. In contrast, such stimulation of anesthetized mice did not result in seizure. Mice were killed at 1 h–7 days after seizure. Brains or regions dissected from brain (neocortex, hippocampus, midbrain, cerebellum) of each group were pooled, single cell suspensions prepared, and cells separated according to density. CD4⁺ (CD3⁺CD45^Hi) and CD8⁺ (CD3⁺CD45^Hi) T cell and CD45R⁺ (CD45^Hi) B cell numbers were determined by flow cytometry. At 24 h after a maximal seizure, CD4⁺ and CD8⁺ T cells and CD45R⁺ B cells appeared in brain, reaching peak numbers at 48 h, but were no longer detected at 7 days. CD4⁺ T cells and CD45R⁺ B cells were preferentially found in neocortex compared with hippocampus, whereas CD8⁺ T cells were preferentially found in hippocampus at 24 h after a maximal seizure. In contrast, virtually no lymphocytes were detected in brains of unstimulated or sham stimulated mice, unanesthetized stimulated mice after submaximal or no seizure, and anesthetized stimulated mice at 1 h–7 day. Neither Ly6-G+ neutrophils nor erythrocytes were detected in brains of any animals, nor was there any detectable increase of blood–brain barrier permeability by uptake of Evans Blue dye. The results indicate that lymphocyte entry into brain after a single brief seizure is due to a selective process of recruitment into cortical regions.     

The influence of preoperative anticoagulation on outcome and quality of life after surgical treatment of chronic subdural hematoma

The main aim of this study was to investigate the influence of perioperative anticoagulation on the clinical course and outcome of 144 patients who underwent surgery for chronic subdural hematoma (CSDH). The outcome was categorized according to the modified Rankin Scale (mRS), Barthel Index and postoperative quality of life (QoL) scale. There was a significant correlation between preoperative aspirin medication and reoperation (Mann–Whitney U-test, p < 0.05). Moreover, dosage and duration of postoperative low-molecular-weight heparin (LMWH) administration were associated with a higher risk of reoperation (Mann–Whitney U-test, p < 0.01) and a worse outcome on the mRS (Mann–Whitney U-test, p < 0.05). Intraoperative treatment with prothrombin complex concentrate led to a poor outcome on the mRS (Craddock-Flood test, p < 0.05). Reoperation is the strongest predictive factor of a poor QoL after surgical treatment of CSDH. Both preoperative and postoperative anticoagulation treatment may affect reoperation rate and, thus, postoperative QoL.     

Quantitative analysis of the effect of brainstem shift on surgical approaches to anterolateral tumors at the craniovertebral junction

Many anterolateral craniovertebral junction (CVJ) tumors can safely be resected using a simple posterolateral approach given the surgical corridor provided by brainstem shift. We sought to study how increasing anterolateral CVJ lesion size affects exposure in the posterolateral and far lateral approaches. Six cadaveric heads were used. A posterolateral approach was performed on one side and a far lateral with one-third condyle resection on the other side. Clival and brainstem exposure and surgical freedom were measured. A balloon catheter was used to simulate 10, 15, and 20 mm anterolateral mass lesions. Mean clival exposure was significantly greater with the far lateral approach (197.4 versus [vs] 135.0 mm², p = 0.03) with no balloon, but this difference disappeared with lesion sizes of 10 mm (246.8 vs 237.9 mm², p = 0.79), 15 mm (306.7 vs 262.4 mm², p = 0.25), and 20 mm (360.0 vs 332.7 mm², p = 0.64). Mean brainstem exposure was significantly greater with the far lateral approach for 0 mm (127.8 vs 65.8 mm², p < 0.01), 10 mm (129.5 vs 87.5 mm², p = 0.045), and 15 mm (140.1 vs 97.8 mm², p = 0.01) lesions. There was no difference at 20 mm (146.7 vs 147.8 mm², p = 0.97). Medial-lateral surgical freedom was greater with the far lateral approach for all sizes. The results of this study provide insight on one important variable in the decision-making process to select the optimal approach for anterolateral CVJ tumors.     

Saving the ischemic penumbra: Endovascular thrombolysis versus medical treatment

Endovascular thrombolysis may allow rapid arterial recanalization in patients with acute ischemic stroke. We present the first study to our knowledge comparing the ischemic penumbra saved with endovascular versus medical therapy. A retrospective review of 21 patients undergoing endovascular intervention for stroke from 2010 to 2011 was contrasted with 21 consecutive patients treated with antiplatelet agents alone. Immediate computed tomography perfusion (CTP) scan of the head and neck was obtained in all patients. Patients with lacunar and posterior circulation infarcts, and those who were medically unstable for MRI post-operatively were excluded. CTP and MRI underwent volumetric calculation. CTP penumbra was correlated with diffusion restriction volumes on MRI, and an assessment was made on the volume of ischemic burden saved with either endovascular treatment or antiplatelet agents. The median age was 70 years (interquartile range 62–80). Median National Institutes of Health Stroke Scale score was 18 and 14 in the control and endovascular groups, respectively. Intravenous tissue plasminogen activator was administered in 22 of 42 patients (52%). Median penumbra calculated was 32,808 mm³ in the control group and 46,255 mm³ in the endovascular group. Median penumbra spared was 9550 mm³ (4980–18,811) in the control group versus 38,155 mm³ in the endovascular group (p = 0.0001). Endovascular thrombolysis may be more efficient than medical therapy alone in saving ischemic penumbra. Future advances in recanalization techniques will further improve the efficacy of endovascular therapy.     

Levetiracetam but not valproate inhibits function of CD8+ T lymphocytes

PurposeTo further elucidate possible immune-modulatory effects of valproate (VPA) or levetiracetam (LEV), we investigated their influence on apoptosis and cytotoxic function of CD8⁺ T lymphocytes in humans.MethodsIn 15 healthy subjects (9 female (60%), 35.7 ± 12.1 years), apoptosis and cytotoxic function of CD8⁺ T lymphocytes were measured using flow cytometry following in vitro exposure to LEV (5 mg/L and 50 mg/L) and VPA (10 mg/L and 100 mg/L). Apoptosis rates were determined after incubation with LEV or VPA for 1 h or 24 h. Cytotoxic function was assessed following 2 h stimulation with mixed virus peptides, using perforin release, CD107a/b expression and proliferation. The presence of synaptic vesicle protein 2A (SV2A) was investigated in human CD8⁺ T lymphocytes by flow cytometry analysis, Western blot and real time polymerase chain reaction (rtPCR).ResultsHigh concentration of LEV decreased perforin release of CD8⁺ T lymphocytes (LEV 50 mg/L vs. CEF only: 21.4% (interquartile range (IQR) 16.5–35.9%) vs. 16.6% (IQR 12–24.9%), p = 0.002). LEV had no influence on apoptosis and proliferation (p > 0.05). VPA (100 mg/L) slowed apoptosis of CD8⁺ T lymphocytes after 24 h (VPA 100 mg/L vs. control: 7.3% (IQR 5.4–9.5%) vs. 11.3% (IQR 8.2–15.1%), p < 0.001), but had no effects on perforin release (p > 0.05). SV2A protein was detected in CD8⁺ T lymphocytes.ConclusionLEV decreased degranulation of CD8⁺ T lymphocytes which may contribute to the increased incidence of upper respiratory tract infections in LEV treated patients. Inhibition of SV2A may be responsible for this effect.     

Neuroprotective effect of anthocyanins on acetylcholinesterase activity and attenuation of scopolamine-induced amnesia in rats

Anthocyanins are a group of natural phenolic compounds responsible for the color to plants and fruits. These compounds might have beneficial effects on memory and have antioxidant properties. In the present study we have investigated the therapeutic efficacy of anthocyanins in an animal model of cognitive deficits, associated to Alzheimer's disease, induced by scopolamine. We evaluated whether anthocyanins protect the effects caused by SCO on nitrite/nitrate (NO_x) levels and Na⁺,K⁺-ATPase and Ca²⁺-ATPase and acetylcholinesterase (AChE) activities in the cerebral cortex and hippocampus (of rats. We used 4 different groups of animals: control (CTRL), anthocyanins treated (ANT), scopolamine-challenged (SCO), and scopolamine + anthocyanins (SCO + ANT). After seven days of treatment with ANT (200 mg kg⁻¹; oral), the animals were SCO injected (1 mg kg⁻¹; IP) and were performed the behavior tests, and submitted to euthanasia. A memory deficit was found in SCO group, but ANT treatment prevented this impairment of memory (P < 0.05). The ANT treatment per se had an anxiolytic effect. AChE activity was increased in both in cortex and hippocampus of SCO group, this effect was significantly attenuated by ANT (P < 0.05). SCO decreased Na⁺,K⁺-ATPase and Ca²⁺-ATPase activities in hippocampus, and ANT was able to significantly (P < 0.05) prevent these effects. No significant alteration was found on NO_x levels among the groups. In conclusion, the ANT is able to regulate cholinergic neurotransmission and restore the Na⁺,K⁺-ATPase and Ca²⁺-ATPase activities, and also prevented memory deficits caused by scopolamine administration.     

Chronic subdural haematomas are more common on the left than on the right

Subdural haematomas (SDHs), and in particular chronic subdural haematomas (CSDHs), are commonly encountered in a neurosurgical practice. The aetiology, presentation, management and prognosis of these are well documented but there are few publications that report on their side prevalence (laterality). We report an analysis of all patients (both operated on and conservatively managed) who presented to the Neurosurgical Service at Christchurch Hospital with SDHs between 1 January 1996 and 30 June 2006.A total of 413 patients presented with a total of 450 SDHs, of which 150 (33.3%) were acute, 38 were (8.4%) subacute and 262 (58.2%) were chronic. The patients ranged in age from 3 months to 95 years. The mean (± standard deviation, SD) age of patients with acute SDH was 50.9 ± 25.8 years, 65.4 ± 19.8 years for subacute SDH and 68.9 ± 19.7 years for chronic SDH. A total of 275 (67%) patients were male and 138 (33%) female, with the male predominance occurring in all subgroups. The SDHs were distributed unilaterally in the acute and subacute groups; however, CSDHs occurred more frequently on the left side (57.2% compared to 42.7% on the right; p = 0.0345). We discuss the likely reasons behind the increased rate of CSDHs diagnoses on the left side.     

The accuracy and reliability of 3D CT/MRI co-registration in planning epilepsy surgery

ObjectiveTo investigate the accuracy and reliability of 3D CT/MRI co-registration technique for the localization of implanted subdural electrodes in the routine epilepsy presurgical evaluation, in so doing assess its usefulness in planning the tailored resection of epileptic focus.MethodsFour external anatomic fiducial makers were used for co-registration of volumetric pre-implant brain MRI and post-implant head CT using Curry 5.0 software in 19 epilepsy presurgical candidates. The location of subdural electrodes derived from the co-registration was compared to that obtained by intra-operative digital photographs by using gyral/sulcal patterns and cortical vasculature as anatomic markers.ResultsThe mean localization error was 4.3 ± 2.5 mm in all 19 patients. However, the mean localization error was 3.1 ±  1.3 mm in 13 patients with all four reliable fiducial markers; whereas the mean localization error was 6.8 ± 2.4 mm in 6 patients with two or three reliable fiducial markers.ConclusionVisualization of subdural electrode positions on a patient’s cortex can be accurately performed in the routine clinical setting by 3D CT/MRI co-registration. However, the accuracy of co-registration is dependent upon having reliable surface fiducial markers. In practice, confirmation of location accuracy, such as with intra-operative digital photographs, is necessary for planning of tailored resective surgery.SignificanceThe combination of 3D CT/MRI co-registration and intra-operative digital photography techniques provides a practical and effective algorithm for the localization and validation of implanted subdural electrodes.     

Time interval to surgery and outcomes following the surgical treatment of acute traumatic subdural hematoma

Although the pre-surgical management of patients with acute traumatic subdural hematoma prioritizes rapid transport to the operating room, there is conflicting evidence regarding the importance of time interval from injury to surgery with regards to outcomes. We sought to determine the association of surgical timing with outcomes for subdural hematoma. A retrospective review was performed of 522 consecutive patients admitted to a single center from 2006–2012 who underwent emergent craniectomy for acute subdural hematoma. After excluding patients with unknown time of injury, penetrating trauma, concurrent cerebrovascular injury, epidural hematoma, or intraparenchymal hemorrhage greater than 30 mL, there remained 45 patients identified for analysis. Using a multiple regression model, we examined the effect of surgical timing, in addition to other variables on in-hospital mortality (primary outcome), as well as the need for tracheostomy or gastrostomy (secondary outcome). We found that increasing injury severity score (odds ratio [OR] 1.146; 95% confidence interval [CI] 1.035–1.270; p = 0.009) and age (OR1.066; 95%CI 1.006–1.129; p = 0.031) were associated with in-hospital mortality in multivariate analysis. In this model, increasing time to surgery was not associated with mortality, and in fact had a significant effect in decreasing mortality (OR 0.984; 95%CI 0.971–0.997; p = 0.018). Premorbid aspirin use was associated with a paradoxical decrease in mortality (OR 0.019; 95%CI 0.001–0.392; p = 0.010). In this patient sample, shorter time interval from injury to surgery was not associated with better outcomes. While there are potential confounding factors, these findings support the evaluation of rigorous preoperative resuscitation as a priority in future study.