title: Risk of Reoperation for Hemorrhage in Patients After Craniotomy.
abstract: OBJECTIVE
  To identify clinical factors predictive of patients returning to the operating room (OR) for hemorrhage after craniotomy.
  
  
  METHODS
  A national surgical quality database (American College of Surgeons National Surgical Quality Improvement Project) was reviewed for patients undergoing craniotomy based on Current Procedural Terminology (CPT) code. CPT codes were also used to identify patients returning to the OR for hemorrhage.
  
  
  RESULTS
  Of 5520 patients who underwent craniotomy in 2012, 81 (1.5%) had a reoperation for hematoma evacuation. Preoperative and intraoperative factors associated with reoperation for hemorrhage included preexisting hypertension, bleeding disorder, and primary craniotomy for hematoma evacuation. Postoperative factors included ventilator dependence >48 hours, unplanned reintubation, and blood transfusion during or after the index operation. A risk score based on these factors was predictive of reoperation for hemorrhage with a receiver operating characteristic area under the curve of 0.767. Restricting the score to preoperative factors was still predictive of reoperation (area under the curve = 0.683).
  
  
  CONCLUSIONS
  Reoperation for evacuation of hematoma is influenced by several clinical factors. A risk score based on these factors is predictive of return to the OR and may be used to identify patients at risk.
authors.affiliation: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA. Electronic address: hanna_algattas@urmc.rochester.edu.
authors.forename: Hanna
authors.initials: H
authors.lastname: Algattas
authors.affiliation: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA.
authors.forename: Kristopher T
authors.initials: KT
authors.lastname: Kimmell
authors.affiliation: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA.
authors.forename: George Edward
authors.initials: GE
authors.lastname: Vates
mesh_terms: D015331:Cohort Studies; D003399:Craniotomy / Q000009:adverse effects*; D016208:Databases, Factual; D005260:Female; D006406:Hematoma / Q000601:surgery; D006801:Humans; D020300:Intracranial Hemorrhages / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000601:surgery*; D011237:Predictive Value of Tests; D064266:Preexisting Condition Coverage; D012372:ROC Curve; D012086:Reoperation / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D024162:Second-Look Surgery
keywords: Craniotomy; Hemorrhage; NSQIP; Reoperation