title: Postoperative computed tomography after surgery for head trauma.
abstract: BACKGROUND
  It is well known that intracranial lesions, which are already diagnosed on preoperative computed tomography, often expand after surgery, and the risk factors have been investigated. On the other hand, we have experienced cases in which new lesions, which were not detected on preoperative computed tomography, were found on postoperative computed tomography. However, little is known about the factors associated with such new postoperative lesions. Here, we investigated the predictive factors of new findings (NFs) on computed tomography early after surgery.
  
  
  METHODS
  We conducted a retrospective registry-based review of 186 consecutive patients who underwent surgery for traumatic brain injury and investigated the prognostic factors of NFs on computed tomography early after surgery.
  
  
  RESULTS
  Mean age was 51 years, and 67.2% were males among the 186 patients. NFs on postoperative computed tomography were observed in 29 patients (15.6%). A univariate analysis showed that Glasgow Coma Scale (GCS) score of 8 or less (p < 0.001), subdural hematoma as the primary indication for surgery (p = 0.012), midline shift (p < 0.001), absence of basal cistern (p < 0.001), and decompressive craniectomy and craniotomy as the surgical procedures (p < 0.001, p = 0.004, respectively) were significantly associated with NFs on postoperative computed tomography. A logistic regression analysis demonstrated that decompressive craniectomy as the surgical procedure (p = 0.001; odds ratio [OR], 8.1; 95% confidence interval [CI], 2.23-28.82), GCS score of 8 or less (p = 0.019; OR, 3.4; 95% CI, 1.23-9.52), and absence of basal cistern (p = 0.023; OR, 3.5; 95% CI, 1.19-10.35) were significant factors.
  
  
  CONCLUSIONS
  Early postoperative computed tomography after surgery for head trauma seems to be warranted in patients presenting with the indicated predictive factors of NFs.
  
  
  METHODS
  Prognostic/therapeutic study, level III.
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Saitama, Japan. s.takeuchi@room.ocn.ne.jp
authors.forename: Satoru
authors.initials: S
authors.lastname: Takeuchi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Takasato
authors.forename: Go
authors.initials: G
authors.lastname: Suzuki
authors.forename: Takuya
authors.initials: T
authors.lastname: Maeda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Masaoka
authors.forename: Takanori
authors.initials: T
authors.lastname: Hayakawa
authors.forename: Naoki
authors.initials: N
authors.lastname: Otani
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yatsushige
authors.forename: Keigo
authors.initials: K
authors.lastname: Shigeta
authors.forename: Toshiya
authors.initials: T
authors.lastname: Momose
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nawashiro
authors.forename: Kentaro
authors.initials: K
authors.lastname: Mori
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011182:Postoperative Care; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices