Article
Extended coagulation screening reduces postoperative haemorrhage rates in cranial neurosurgery
Erweiterte Gerinnungsdiagnostik verringert die Nachblutungsrate nach kraniellen Eingriffen
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Authors
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Arthur Wagner
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik, München, Deutschland
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Frederik Hartz
- Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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Erik Hameister
- Klinikum rechts der Isar, Technische Universität München, München, Deutschland; Klinikum rechts der Isar, Technische Universität München, Institut für klinische Chemie, München, Deutschland
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Christof Winter
- Klinikum rechts der Isar, Technische Universität München, Institut für klinische Chemie, München, Deutschland
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Bernhard Meyer
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik, München, Deutschland
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Maria Wostrack
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik, München, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Postoperative hemorrhage after cranial neurosurgery is a serious complication with substantial morbidity and mortality despite immediate intervention. We investigated the preoperative screening and substitution of previously undetected coagulopathies as a measure to decrease the risk of postoperative hemorrhage.
Methods: A study cohort of patients undergoing elective cranial surgery and receiving the extended coagulatory work-up were compared to a propensity matched historical cohort. Propensity matching was carried out in a 1:1 fashion according to age, gender and type of intervention. 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® in addition to the standard parameters consisting of the prothrombin time, partial thromboplastin time and thrombocyte count. Deficiencies in any parameter were substituted perioperatively. The primary outcome was determined as the surgical revision rate due to postoperative hemorrhage.
Results: The study cohort and the historical 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. Replacement of coagulation factors was significantly more common in the study cohort (70 cases; 35.5%) than in the historical cohort (43 cases; 21.8%; p=.003). Imaging revealed postoperative hemorrhage in 7 cases (3.6%) in the study cohort and 18 cases (9.1%) in the historical cohort (p=.023). Of these, revision surgeries were significantly more common in the historical 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 historical cohort (p=.376).
Conclusion: Preoperative extended coagulatory screening may allow for adequate substitution of coagulatory factors and thereby reduce the risk for postoperative hemorrhage in cranial neurosurgery.
