title: Flurbiprofen and hypertension but not hydroxyethyl starch are associated with post-craniotomy intracranial haematoma requiring surgery.
abstract: BACKGROUND
  Post-craniotomy intracranial haematoma is one of the most serious complications after neurosurgery. We examined whether post-craniotomy intracranial haematoma requiring surgery is associated with the non-steroidal anti-inflammatory drugs flurbiprofen, hypertension, or hydroxyethyl starch (HES).
  
  
  METHODS
  A case-control study was conducted among 42 359 patients who underwent elective craniotomy procedures at Beijing Tiantan Hospital between January 2006 and December 2011. A one-to-one control group without post-craniotomy intracranial haematoma was selected matched by age, pathologic diagnosis, tumour location, and surgeon. Perioperative blood pressure records up to the diagnosis of haematoma, the use of flurbiprofen and HES were examined. The incidence of post-craniotomy intracranial haematoma and the odds ratios for the risk factors were determined.
  
  
  RESULTS
  A total of 202 patients suffered post-craniotomy intracranial haematoma during the study period, for an incidence of 0.48% (95% CI=0.41-0.55). Haematoma requiring surgery was associated with an intraoperative systolic blood pressure of >160 mm Hg (OR=2.618, 95% CI=2.084-2.723, P=0.007), an intraoperative mean blood pressure of >110 mm Hg (OR=2.600, 95% CI=2.312-3.098, P=0.037), a postoperative systolic blood pressure of >160 mm Hg (OR=2.060, 95% CI= 1.763-2.642, P=0.022), a postoperative mean blood pressure of >110 mm Hg (OR=3.600, 95% CI= 3.226-4.057, P=0.001), and the use of flurbiprofen during but not after the surgery (OR=2.256, 95% CI=2.004-2.598, P=0.005). The intraoperative infusion of HES showed no significant difference between patients who had a haematoma and those who did not.
  
  
  CONCLUSIONS
  Intraoperative and postoperative hypertension and the use of flurbiprofen during surgery are risk factors for post-craniotomy intracranial haematoma requiring surgery. The intraoperative infusion of HES was not associated with a higher incidence of haematoma.
authors: Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Beijing 100050, China.
authors: M
authors: M
authors: Jian
authors: Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Beijing 100050, China.
authors: X
authors: X
authors: Li
authors: Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Beijing 100050, China.
authors: A
authors: A
authors: Wang
authors: Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University, Beijing, China.
authors: L
authors: L
authors: Zhang
authors: Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Beijing 100050, China ruquan.han@gmail.com.
authors: R
authors: R
authors: Han
authors: Department of Anaesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA.
authors: A W
authors: AW
authors: Gelb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001794:Blood Pressure / Q000502:physiology; D001802:Blood Substitutes / Q000009:adverse effects*; D016022:Case-Control Studies; D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D005480:Flurbiprofen / Q000009:adverse effects*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects*; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology*; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001802:Blood Substitutes; D006895:Hydroxyethyl Starch Derivatives; D005480:Flurbiprofen
keywords: flurbiprofen; hydroxyethyl starch; hypertension; postoperative haemorrhage