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Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
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Specific causes and predictors of readmissions following acute and chronic subdural hematoma evacuation

Nikita Lakomkin1, Christopher S Graffeo2, Constantinos G Hadjipanayis1

  • 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, USA; Department of Neurosurgery, Icahn School of Medicine, Mount Sinai Beth Israel, Mount Sinai Health System, USA.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|April 5, 2020
PubMed

Insights

Patients undergoing craniotomy for subdural hematoma (SDH) evacuation face higher readmission rates. Key predictors include hypertension and abnormal INR for chronic SDH, and UTI and stroke for acute SDH, guiding future preventative strategies.

Area of Science:

  • Neurosurgery
  • Public Health
  • Medical Informatics

Background:

  • Craniotomy for subdural hematoma (SDH) evacuation is associated with higher readmission rates compared to other neurosurgical procedures.
  • Predictive factors for readmission after SDH craniotomy are not fully understood, necessitating further investigation.

Purpose of the Study:

  • To identify factors predicting 30-day readmission following craniotomy for subdural hematoma (SDH) of any etiology.
  • To differentiate readmission predictors based on SDH type (acute vs. chronic).

Main Methods:

  • Utilized the National Surgical Quality Improvement (NSQIP) database from 2012-2014.
  • Included 1024 patients undergoing craniotomy for SDH.
  • Employed binary logistic regression to identify readmission predictors.

Main Results:

  • 10.6% of patients (109/1024) were readmitted within 30 days.
  • Common readmission causes: recurrent SDH (33.3%), seizure (9.9%), new neurological deficit (7.4%), stroke (7.4%), and altered mental status (AMS) (7.4%).
  • Hypertension and abnormal INR predicted readmission for chronic SDH; postoperative UTI and stroke predicted readmission for acute SDH.

Conclusions:

  • Readmission after chronic SDH is linked to recurrent hemorrhage.
  • Seizures, AMS, and neurological deficits are key drivers for readmission after acute/traumatic SDH.
  • Optimizing anticoagulation and antihypertensive management may reduce readmissions for chronic SDH.

Keywords:
Adverse eventsAnticoagulationComplicationsTrauma

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