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Abstract：
Background and aim Reoperation rate is defined as the percentage of patients returning to the operating room (OR) within 30 days of an initial craniotomy and undergoing a repeat (redo) craniotomy procedure. It is a key factor of quality-of-care assessments and has implications for outcomes, especially in oncological cases. Redo craniotomies are associated with improvement in neurological status and decreased mortality rate compared to non-surgical interventions but are associated with higher costs and risk of complications. It is important to gauge the indications and frequency of redo craniotomies as an index of quality of healthcare to improve patient outcomes. This study aimed to identify the indications, frequency, and outcomes of reoperation following an initial craniotomy in neurosurgical patients at a tertiary care hospital. Methods This retrospective cohort study was conducted at a tertiary care center in Pakistan and included all patients who underwent unplanned reoperation within 30 days of initial craniotomy from January 1, 2010, to December 31, 2017. Demographics, indications for index surgery as well as reoperation, and outcomes in the form of complications, neurological status, and mortality were collected from medical charts and analyzed. Results The study comprised 111 patients who underwent reoperations. Median age of the patients was 36 years (interquartile range {IQR}: 33 years). From a total of more than 1900 annual cases, the frequency of unplanned reoperations was 3.5%. The most common indication of unplanned reoperation based on MRI/CT was hemorrhage (40%, subdural hemorrhage was most common), followed by hydrocephalus (22%), cerebral edema (13%), and residual tumor (13%). The most common clinical reason for unplanned reoperation was a drop in Glasgow Coma Scale (GCS) (59%), whereas anisocoria was seen in 10.8% of patients. The highest mortality rate was observed in patients who were reoperated from post-operative day two to post-operative day seven (56%). Hypertension (p=0.014) and thrombocytopenia (p<0.001) showed significant associations with developing intracranial hemorrhage. Seventy-eight percent of patients showed significant improvement in their Karnofsky Performance Score (KPS) whereas 22% showed deterioration in their KPS. Conclusion The delivery of consistent quality healthcare relies on early detection and intervention in at-risk patients. Our center\'s reoperation rate is consistent with the average range among other centers globally. Hypertension, anticoagulation, and antiplatelet therapy were common risk factors for redo craniotomies within 30 days. Patients with these conditions need special care to prevent returns to the operating room. Patients also need to be monitored for hemorrhage in the short term (one to two days) and hydrocephalus in the long term (two to 30 days) to intervene early if needed.
摘要：
背景和目的再手术率定义为在初次开颅手术并进行重复（重做）开颅手术后30天内返回手术室（OR）的患者百分比。它是护理质量评估的关键因素，对结果有影响，尤其是在肿瘤病例中。与非手术干预相比，重新开颅手术与神经系统状况的改善和死亡率的降低有关，但与更高的成本和并发症的风险有关。重要的是要衡量再行开颅手术的适应症和频率，作为改善患者预后的医疗保健质量指标。本研究旨在确定适应症，频率,以及三级医院神经外科患者初次开颅手术后再次手术的结果。方法这项回顾性队列研究在巴基斯坦的三级护理中心进行，包括2010年1月1日至2017年12月31日在初次开颅手术30天内接受非计划再次手术的所有患者。人口统计,指征手术和再手术，以及并发症形式的结果，神经状况,从医学图表中收集和分析死亡率。结果本研究包括111例再次手术的患者。患者的中位年龄为36岁(四分位距{IQR}:33岁)。从每年1900多例病例中，计划外再手术的频率为3.5%。基于MRI/CT的非计划再次手术的最常见指征是出血（40％，硬膜下出血最常见)，其次是脑积水(22%)，脑水肿（13%），和残留肿瘤（13%）。计划外再手术最常见的临床原因是格拉斯哥昏迷评分（GCS）下降（59%）。而在10.8%的患者中观察到不适。在术后第二天至术后第七天再次手术的患者中观察到最高的死亡率（56％）。高血压（p=0.014）和血小板减少症（p<0.001）与颅内出血的发生显着相关。78％的患者的Karnofsky性能评分（KPS）显着改善，而22％的患者的KPS恶化。结论提供高质量的医疗保健依赖于对高危患者的早期发现和干预。我们中心的再手术率与全球其他中心的平均范围一致。高血压,抗凝,抗血小板治疗是30天内再次开颅手术的常见危险因素.患有这些疾病的患者需要特别护理，以防止返回手术室。还需要监测患者短期（一到两天）的出血和长期（两到30天）的脑积水，以便在需要时进行早期干预。
