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Abstrakt

Introduction: Acute subdural hematoma (aSDH) removal is one of the most commonly performed procedure in neurosurgery. Complications of those surgeries which require reoperation are associated with higher risk of poor treatment outcome. Th erefore we decided to analyse potential factors which might be associated with risk of early reoperation among patients who underwent aSDH surgery. Material and methods: We retrospectively analysed 328 patients treated due to aSDH. From their medical records we obtained detailed medical history. Early reoperation was defi ned as reoperation during the same hospital stay. To determine the potential predictors of early reoperation we used univariate and multivariate logistic regression analyses. Results: A total of 20 (6.09%) patients required early reoperation. Th ose patients had signifi cantly higher International Normalized Ratio (INR) upon admission (1.96 ± 2.55 vs. 1.26 ± 0.50; p <0.01) and signifi cantly higher Prothrombin Time (PT) upon admission (21.84 ± 27.10 vs. 13.40 ± 3.45; p <0.01). In multivariate logistic regression analysis aft er adjustment for all possible confounders higher INR (OR: 1.762; 95% CI: 1.017–22.840; p = 0.045) remained independently associated with higher risk of early reoperation among patients with aSDH. Conclusions: Patients with higher INR and PT upon admission are at higher risk of early reoperation. Higher INR is independently associated with higher risk of early reoperation among patients with aSDH.
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Abstrakt

I n t r o d u c t i o n: Complications occurring aft er neurosurgical procedures which lead to reoperations are associated with poor treatment outcomes. Th e aim of our study was to establish predictive factors of unplanned early reoperations aft er intracranial meningioma removal. Ma t e r i a l s a n d M e t h o d s: We retrospectively analyzed 177 patients who underwent craniotomy due to an intracranial meningioma. Early reoperation was defi ned as reoperation during the same hospital stay. We used a χ2 test for proportional values and t-test and Mann-Whitney U tests as appropriate for continuous variables. To determine the potential predictors of early reoperation we used univariate and multivariate logistic regression analyses. R e s u l t s: A total of 13 (7.34%) patients underwent unplanned early reoperation. Th ese patients underwent retrosigmoid craniotomies (25.00% vs. 6.40%; p = 0.047), suff ered from ischemic heart disease (66.67% vs. 6.64%; p <0.01) and atrial fi brillation (60.00% vs. 6.25%; p <0.01), were receiving heparin (50.00% vs. 6.74%; p <0.01) and anticoagulants (66.67% vs. 6.21%; p <0.01) signifi cantly more oft en than the general study population. In multivariate logistic regression analysis anticoagulant use (OR: 31.463; 95% CI: 1.139–868.604; p = 0.04) and retrosigmoid craniotomy (OR: 6.642; 95% CI: 1.139–38.73; p = 0.034) remained independently associated with a higher risk of early reoperation. C o n c l u s i o n s: Patients who underwent retrosigmoid craniotomy, those with a history of ischemic heart disease or atrial fi brillation and those who take heparin or anticoagulants are more likely to require early reoperation. Retrosigmoid craniotomy and anticoagulant use are independent risk factors for early reoperation.
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