Postoperative hematoma: a 5-year survey and identification of avoidable risk factors.
This study examines the surgical practice at the Wessex Neurological Centre over the 5-year period from 1989 to 1993 to determine the incidence of postoperative hematoma and to identify risk factors for a perioperative bleeding disorder. The study includes only those postoperative hematomas (at any site) that followed and were related to a neurosurgical operation and were surgically evacuated. The study is prospective for the year 1993 and retrospective for the preceding years. Over the 5 years, 6668 operations were performed and 71 postoperative hematomas were surgically evacuated, accounting for an overall rate of 1.1% of operations. The records were available for 69 cases. The most frequent diagnosis leading to postoperative hematoma was meningioma surgery with a rate of 6.2% of cases (13 of 211); followed by craniotomy for trauma, 3.7% (7 of 192); aneurysm surgery, 2.6% (11 of 428); and intrinsic supratentorial tumors, 2.2% (10 of 451). Postoperative hematomas were intraparenchymal in 43% of cases, subdural in 5%, extradural in 33%, mixed in 8%, and confined to the superficial wound in 11%. The overall mortality was 32% (37% for intraparenchymal and 12% for extradural). Risk factors for a perioperative bleeding disorder were present in two-thirds of the patients. Administration of antiplatelet agents (aspirin and nonsteroidal anti-inflammatory drugs) was the most commonly associated risk factor. At least 75% of these identified risk factors could potentially have been avoided or corrected.
Palmer
J D
JD
Wessex Neurological Centre, Southampton University Hospitals, United Kingdom.
Sparrow
O C
OC
Iannotti
F
F
D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D002423:Cause of Death; D002493:Central Nervous System Diseases / Q000401:mortality / Q000601:surgery*; D016543:Central Nervous System Neoplasms / Q000401:mortality / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control / Q000601:surgery*; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology / Q000401:mortality / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013118:Spinal Cord Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control / Q000601:surgery*; D015996:Survival Rate
D000925:Anticoagulants