The Clinical Value of Intraoperative Mobile Computed Tomography in Managing High-Risk Surgical Patients with Traumatic Brain Injury-A Single Tertiary Trauma Center Experience

Use of Hematocrit for Short-Term Prognosis of Patients with Traumatic Brain Injury After Decompressive Craniectomy

OBJECTIVE

To discuss the effects of the hematocrit (Hct) in patients with traumatic brain injury after decompressive craniectomy (DC).

METHODS

Demographic data, inspection and treatment procedures, and 30-day prognosis were obtained for 158 patients with head injury who underwent unilateral DC in our hospital between January 2013 and June 2018. Uni- and multivariate logistic regression was applied to analyze independent risk factors for 30-day outcome. The quantitative analysis of postoperative Hct, ΔHct (postoperative Hct minus initial Hct), and their combination for the prognosis of patients with TBI was displayed graphically using receiver operating characteristic (ROC) curves. Multiple linear regression was used to explore factors influencing postoperative Hct and ΔHct.

RESULTS

Short-term mortality was 29.7%. Uni- and multivariate logistic regression analysis showed that age (odds ratio [OR], 1.064; P = 0.024), Glasgow Coma Scale score (OR, 0.711; P = 0.027), Injury Severity Score (ISS) (OR, 1.156; P = 0.047), midline shift in millimeters (OR, 1.809; P <0.001), postoperative Hct (OR, 0.743; P = 0.001), and ΔHct (OR, 1.242; P =0.048) were independent risk factors for short-term death. In ROC curves, a combination of postoperative Hct and ΔHct showed the highest sensitivity (77.5%) and highest specificity (89.4%). When using this combination to predict prognosis, we could achieve an accuracy of 94.5%. ISS (β = -0.172, P = 0.022), initial Hct (β = 0.243, P = 0.001), principal hematoma location (β = -2.628, P < 0.001), hours of operation (β = -0.884, P = 0.048), and colloid quantity (β = -0.002, P = 0.001) were independent contributing factors for ΔHct, which was similar to postoperative Hct.

CONCLUSIONS

A combination of postoperative Hct and ΔHct could better predict short-term survival of patients with TBI. Developing an appropriate treatment strategy to increase postoperative Hct and reduce the ΔHct may be good for the short-term prognosis of patients with TBI after DC.

Analysis of Unplanned Return to the Operating Room Within 30 Days of Initial Neurosurgery: A 3-Year Experience at a Single Center

OBJECTIVE

The goal of this study was to evaluate the reasons and prognosis of unplanned return to the operating room (URTOR) and to help improve neurosurgical service quality.

METHODS

Medical records of URTOR within 30 days of initial surgery were reviewed at a single neurosurgical center for a period of 3 years. Out of 4516 neurosurgeries, 62 URTOR cases were included to analyze patients' age, sex, initial surgery code, seniority of the performed surgeon, interval between the reopening procedures and initial procedures, reason for reopening, prognosis, and complications.

RESULTS

The 62 patients underwent 70 URTORs. Out of 1445 primary operations performed by junior surgeons, 40 experienced URTOR, whereas 22 of 3071 craniotomies initially performed by senior surgeons resulted in URTOR. Five patients died in this series. Out of the 54 patients who experienced 1-time URTOR, 3 died, whereas 2 of the 8 patients who experienced 2-time URTOR died. Of 22 URTOR surgeries performed by senior surgeons, 10 took place within 24 hours, compared with 26 out of 48 performed by the junior surgeon.

CONCLUSIONS

The main reasons for URTOR after neurosurgery were rebleeding and swelling of the brain. The number of URTORs and time from primary craniotomy to URTOR are not associated with morbidity or mortality. However, the seniority of the surgeon affects the rate of URTOR: surgeons with rich experience in surgery may reduce the chance of a second craniotomy and increase the chance of a good prognosis.