Specific causes and predictors of readmissions following acute and chronic subdural hematoma evacuation |
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| Institution: | 1. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, USA;2. Department of Neurosurgery, Icahn School of Medicine, Mount Sinai Beth Israel, Mount Sinai Health System, USA;3. Department of Neurologic Surgery, Mayo Clinic, USA;1. Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;2. McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA;3. West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, Pennsylvania, USA;1. Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Japan;2. Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan;1. Faculty of Medicine, University of Turku, Turku, Finland;2. Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital and University of Turku, Turku, Finland;3. Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland;4. Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland;5. Neurovascular Surgery Program, Section of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA;6. Department of Neurology, University of Turku, Turku, Finland;1. Case Western Reserve University School of Medicine, Cleveland, Ohio, USA;2. Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;3. Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;4. Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;5. Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;6. David Grant Medical Center, Travis Airforce Base, Fairfield, California, USA;7. Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA;1. Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA;2. McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, PA, 19104, USA;3. West Chester University, The West Chester Statistical Institute and Department of Mathematics, 25 University Ave, West Chester, PA, 19383, USA |
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| Abstract: | Patients treated with craniotomy for subdural hematoma (SDH) evacuation have a higher readmission incidence when compared to other neurosurgical patients. Factors predictive of readmission following craniotomy for SDH are incompletely understood. The National Surgical Quality Improvement (NSQIP) database was queried for all patients treated by craniotomy for SDH of any etiology (e.g. acute, chronic, spontaneous, traumatic) during the study period (2012–2014). Patients requiring repeat hospitalization within 30 days of surgery were identified and classified by reason for readmission. Binary logistic regression analysis was used to identify predictors of readmission. 1024 patients met inclusion criteria, among whom 109 (10.6%) were readmitted within 30 days. The most common causes of readmission were recurrent SDH (n = 27; 33.3%), seizure (n = 8; 9.9%), new neurological deficit (n = 6; 7.4%), stroke (n = 6; 7.4%), and altered mental status (AMS) (n = 6; 7.4%). Multivariable modeling identified hypertension requiring medication (OR = 2.78, P = 0.013) and abnormal INR (OR = 2.66, P = 0.035) as significantly associated with readmission following chronic SDH, while postoperative UTI (OR = 3.64, P = 0.01) and stroke (OR = 4.86, P = 0.018) were significant predictors of readmission following acute SDH. Readmission was associated with recurrent hemorrhage after chronic/spontaneous SDH, while seizures, AMS, and neurological deficits drove readmissions after acute/traumatic SDH. Careful management of anticoagulation and antihypertensive medications may be helpful in reducing the risk of readmission following craniotomy for chronic SDH. |
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| Keywords: | Anticoagulation Adverse events Complications Trauma |
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