Craniotomy versus craniectomy for traumatic acute subdural hematoma-coarsened exact matched analysis of outcomes.

Autor: Ran KR; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: kran2@jh.edu., Vattipally VN; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Giwa GA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Myneni S; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Raj D; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Dardick JM; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Rincon-Torroella J; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Ye X; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Byrne JP; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Suarez JI; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Lin SC; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Jackson CM; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Mukherjee D; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Gallia GL; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Huang J; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Weingart JD; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Azad TD; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Bettegowda C; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jazyk: angličtina
Zdroj: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia [J Clin Neurosci] 2024 Jan; Vol. 119, pp. 52-58. Date of Electronic Publication: 2023 Nov 18.
DOI: 10.1016/j.jocn.2023.11.021
Abstrakt: Background and Objectives: Acute subdural hematoma (aSDH) after traumatic brain injury frequently requires emergent craniotomy (CO) or decompressive craniectomy (DC). We sought to determine the variables associated with either surgical approach and to compare outcomes between matched patients.
Methods: A multi-center retrospective review was used to identify traumatic aSDH patients who underwent CO or DC. Patient variables independently associated with surgical approach were used for coarsened exact matching.Multivariate logistic regression and multivariate Cox proportional-hazards regression wereconducted on matched patients to determine independent predictors of mortality.
Results: Seventy-six patients underwent CO and sixty-two underwent DC for aSDH evacuation. DC patients were21.4 years younger (P < 0.001), more likely to be male (80.6 % vs 60.5 %,P = 0.011), and present with GCS ≤ 8 (64.5 % vs 36.8 %,P = 0.001). Age (P < 0.001), epidural hematoma (P = 0.01), skull fracture (P = 0.001), and cisternal effacement (P = 0.02) were independently associated with surgical approach. After coarsened exact matching, DC (P = 0.008), older age (P = 0.007), male sex (P = 0.04), and intraventricular hemorrhage (P = 0.02), were independently associated with inpatient mortality. Multivariate Cox proportional-hazards regression demonstrated that DC was independently associated with mortality at 90-days (P = 0.001) and 1-year post-operation (P = 0.003).
Conclusion: aSDH patients who receive surgical evacuation via DC as opposed to CO are younger, more likely to be male, and have worse clinical exam. After controlling for patient differences via coarsened exact matching, DC is independently associated with mortality.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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