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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Surgery 1/2015

The value of intraoperative intracranial pressure monitoring for predicting re-operation using salvage decompressive craniectomy after craniotomy in patients with traumatic mass lesions

Zeitschrift:
BMC Surgery > Ausgabe 1/2015
Autoren:
He-xiang Zhao, Yi Liao, Ding Xu, Qiang-ping Wang, Qi Gan, Chao You, Chao-hua Yang
Wichtige Hinweise

Competing of interests

The authors declare that they have no competing interests.

Authors’ contributions

HXZ designed the study, performed statistical analyses, interpreted the results and drafted the manuscript. YL, DX, QPW, QG participated in data collection, performed statistical analyses, interpreted the results and helped obtain Ethics Committee approval. CY designed the study, interpreted the results and helped in critical revision of the manuscript. CHY conceptualised and designed the study, interpreted the results, drafted the manuscript and supervised the study. All authors read, edited and approved the final manuscript.

Abstract

Background

The risk factors of predicting the need for postoperative decompressive craniectomy due to intracranial hypertension after primary craniotomy remain unclear. This study aimed to investigate the value of intraoperative intracranial pressure (ICP) monitoring in predicting re-operation using salvage decompressive craniectomy (SDC).

Methods

From January 2008 to October 2014, we retrospectively reviewed 284 patients with severe traumatic brain injury (STBI) who underwent craniotomy for mass lesion evacuation without intraoperative brain swelling. Intraoperative ICP was documented at the time of initial craniotomy and then again after the dura was sutured. SDC was used when postoperative ICP was continually higher than 25 mmHg for 1 h without a downward trend. Univariate and multivariate analyses were applied to both initial demographic and radiographic features to identify risk factors of SDC requirement.

Results

Of 284, 41 (14.4 %) patients who underwent SDC had a higher Initial ICP than those who didn’t (38.1 ± 9.2 vs. 29.3 ± 8.1 mmHg, P < 0.001), but there was no difference in ICP after the dura was sutured. The factors which have significant effects on SDC are higher initial ICP [odds ratio (OR): 1.100, 95 % confidence interval (CI): 1.052–1.151, P < 0.001], older age (OR: 1.039, 95 % CI: 1.002–1.077, P = 0.039), combined lesions (OR: 3.329, 95 % CI: 1.199–9.244, P = 0.021) and early hypotension (OR: 2.524, 95 % CI: 1.107–5.756, P = 0.028). The area under the curve of multivariate regression model was 0.771.

Conclusions

The incidence of re-operation using SDC after craniotomy was 14.4 %. The independent risk factors of SDC requirement are initial ICP, age, early hypotension and combined lesions.
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