The role of extended coagulation screening in adult cranial neurosurgery
© 2023 The Authors..
Introduction: Postoperative hemorrhage after adult cranial neurosurgery is a serious complication with substantial morbidity and mortality.
Research question: We investigated if an extended preoperative screening and an early treatment of previously undetected coagulopathies may decrease the risk of postoperative hemorrhage.
Methods: A prospective study cohort of patients undergoing elective cranial surgery and receiving the extended coagulatory work-up were compared to a propensity matched historical control cohort. The extended work-up included a standardized questionnaire on the patient's bleeding history as well as coagulatory tests of Factor XIII, von-Willebrand-Factor and PFA-100®. Deficiencies were substituted perioperatively. The primary outcome was determined as the surgical revision rate due to postoperative hemorrhage.
Results: The study cohort and the control cohort included 197 cases each, without any significant difference in the preoperative intake of anticoagulant medication (p = .546). Most common interventions were resections of malignant tumors (41%), benign tumors (27%) and neurovascular surgeries (9%) in both cohorts. Imaging revealed postoperative hemorrhage in 7 cases (3.6%) in the study cohort and 18 cases (9.1%) in the control cohort (p = .023). Of these, revision surgeries were significantly more common in the control cohort with 14 cases (9.1%) compared to 5 cases (2.5%) in the study cohort (p = .034). Differences in mean intraoperative blood loss were not significant with 528 ml in the study cohort and 486 ml in the control cohort (p = .376).
Conclusion: Preoperative extended coagulatory screening may allow for revealing previously undiagnosed coagulopathies with subsequent preoperative substitution and thereby reduction of risk for postoperative hemorrhage in adult cranial neurosurgery.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:3 |
|---|---|
| Enthalten in: |
Brain & spine - 3(2023) vom: 18., Seite 101756 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Wagner, Arthur [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Coagulation substitution |
|---|
| Anmerkungen: |
Date Revised 02.07.2023 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
|---|
| doi: |
10.1016/j.bas.2023.101756 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM35884746X |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM35884746X | ||
| 003 | DE-627 | ||
| 005 | 20231226075622.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.bas.2023.101756 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1196.xml |
| 035 | |a (DE-627)NLM35884746X | ||
| 035 | |a (NLM)37383462 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Wagner, Arthur |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The role of extended coagulation screening in adult cranial neurosurgery |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 02.07.2023 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2023 The Authors. | ||
| 520 | |a Introduction: Postoperative hemorrhage after adult cranial neurosurgery is a serious complication with substantial morbidity and mortality | ||
| 520 | |a Research question: We investigated if an extended preoperative screening and an early treatment of previously undetected coagulopathies may decrease the risk of postoperative hemorrhage | ||
| 520 | |a Methods: A prospective study cohort of patients undergoing elective cranial surgery and receiving the extended coagulatory work-up were compared to a propensity matched historical control cohort. The extended work-up included a standardized questionnaire on the patient's bleeding history as well as coagulatory tests of Factor XIII, von-Willebrand-Factor and PFA-100®. Deficiencies were substituted perioperatively. The primary outcome was determined as the surgical revision rate due to postoperative hemorrhage | ||
| 520 | |a Results: The study cohort and the control cohort included 197 cases each, without any significant difference in the preoperative intake of anticoagulant medication (p = .546). Most common interventions were resections of malignant tumors (41%), benign tumors (27%) and neurovascular surgeries (9%) in both cohorts. Imaging revealed postoperative hemorrhage in 7 cases (3.6%) in the study cohort and 18 cases (9.1%) in the control cohort (p = .023). Of these, revision surgeries were significantly more common in the control cohort with 14 cases (9.1%) compared to 5 cases (2.5%) in the study cohort (p = .034). Differences in mean intraoperative blood loss were not significant with 528 ml in the study cohort and 486 ml in the control cohort (p = .376) | ||
| 520 | |a Conclusion: Preoperative extended coagulatory screening may allow for revealing previously undiagnosed coagulopathies with subsequent preoperative substitution and thereby reduction of risk for postoperative hemorrhage in adult cranial neurosurgery | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Coagulation substitution | |
| 650 | 4 | |a Complication | |
| 650 | 4 | |a Cranial surgery | |
| 650 | 4 | |a Extended coagulation | |
| 650 | 4 | |a Postoperative hemorrhage | |
| 700 | 1 | |a Wostrack, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Hartz, Frederik |e verfasserin |4 aut | |
| 700 | 1 | |a Heim, Johannes |e verfasserin |4 aut | |
| 700 | 1 | |a Hameister, Erik |e verfasserin |4 aut | |
| 700 | 1 | |a Hildebrandt, Martin |e verfasserin |4 aut | |
| 700 | 1 | |a Meyer, Bernhard |e verfasserin |4 aut | |
| 700 | 1 | |a Winter, Christof |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Brain & spine |d 2021 |g 3(2023) vom: 18., Seite 101756 |w (DE-627)NLM347623549 |x 2772-5294 |7 nnns |
| 773 | 1 | 8 | |g volume:3 |g year:2023 |g day:18 |g pages:101756 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.bas.2023.101756 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 3 |j 2023 |b 18 |h 101756 | ||