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Updated: Apr 3, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Risk of Reoperation for Hemorrhage in Patients After Craniotomy
Hanna Algattas1, Kristopher T Kimmell1, George Edward Vates1
1Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA.
Insights
Clinical factors predict return to the operating room (OR) for hemorrhage after craniotomy. A risk score identifies patients needing reoperation for hematoma evacuation, aiding clinical decision-making.
Area of Science:
- Neurosurgery
- Surgical Outcomes
- Patient Safety
Background:
- Hemorrhage requiring reoperation after craniotomy is a significant concern.
- Identifying predictive factors for reoperation is crucial for patient management.
Purpose of the Study:
- To identify clinical factors that predict patients returning to the operating room (OR) for hemorrhage after craniotomy.
Main Methods:
- Utilized the American College of Surgeons National Surgical Quality Improvement Project database.
- Analyzed patient data using Current Procedural Terminology (CPT) codes to identify craniotomies and subsequent reoperations for hemorrhage.
Main Results:
- 1.5% of 5520 patients required reoperation for hematoma evacuation.
- Predictive factors included hypertension, bleeding disorders, primary hematoma craniotomy, prolonged ventilator dependence, unplanned reintubation, and blood transfusion.
- A risk score demonstrated predictive value (AUC=0.767), with preoperative factors also being predictive (AUC=0.683).
Conclusions:
- Several clinical factors influence the need for reoperation after craniotomy due to hemorrhage.
- A developed risk score can predict reoperation for hematoma evacuation, aiding in identifying at-risk patients.
Objective:
To identify clinical factors predictive of patients returning to the operating room (OR) for hemorrhage after craniotomy.
Methods:
A national surgical quality database (American College of Surgeons National Surgical Quality Improvement Project) was reviewed for patients undergoing craniotomy based on Current Procedural Terminology (CPT) code. CPT codes were also used to identify patients returning to the OR for hemorrhage.
Results:
Of 5520 patients who underwent craniotomy in 2012, 81 (1.5%) had a reoperation for hematoma evacuation. Preoperative and intraoperative factors associated with reoperation for hemorrhage included preexisting hypertension, bleeding disorder, and primary craniotomy for hematoma evacuation. Postoperative factors included ventilator dependence >48 hours, unplanned reintubation, and blood transfusion during or after the index operation. A risk score based on these factors was predictive of reoperation for hemorrhage with a receiver operating characteristic area under the curve of 0.767. Restricting the score to preoperative factors was still predictive of reoperation (area under the curve = 0.683).
Conclusions:
Reoperation for evacuation of hematoma is influenced by several clinical factors. A risk score based on these factors is predictive of return to the OR and may be used to identify patients at risk.
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