Highlights
- •Overall, chronic SDH readmissions are predominantly attributable to recurrence.
- •Acute SDH readmissions are more likely due to a variety of neurologic complications.
- •INR derangements or hypertension were predictive of readmissions in chronic SDH.
- •In-hospital adverse events were associated with readmission following acute SDH.
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.
Keywords
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Article info
Publication history
Published online: March 31, 2020
Accepted:
March 21,
2020
Received:
January 12,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
