Risk of Reoperation for Hemorrhage in Patients After Craniotomy

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.