Analysis Of Influencing Factors And Nomogram Construction Of Reoperation For Hemorrhage In Patients With Severe Traumatic Brain Injury

Objective: To explore the independent risk factors of reoperation for hemorrhage after craniotomy in patients with severe traumatic brain injury(s TBI),and to build a nomogram model for predicting reoperation after craniotomy in patients with s TBI.Methods: A retrospective case-control study was performed.A total of 366 patients with s TBI who were diagnosed and met the inclusion and exclusion criteria in the Department of Neurosurgery of the affiliated Hospital of Zunyi Medical University from January 2015 to December 2020 were collected.All of them were treated with emergency decompressive craniectomy,including 285 males and 81 females,aged 1-87years,with an average of 42.4 years.The injury causes included: 124 cases of road traffic injuries,217 cases of fall and falling injuries,14 cases of beating injury,and 11 other cases.They were divided into reoperation group and non-reoperation group according to whether there was bleeding reoperation within one week after operation.Through univariate binary logistic regression analysis,the possible risk factors were screened out.Then,the independent risk factors of reoperation for postoperative bleeding were screened by the forward step method of multivariate binary logistic regression analysis,and the corresponding nomogram model was constructed.The ROC curve was used to evaluate the reliability of the model.Then,the model was internally validated using 1000 bootstrap samples.Results: The rate of bleeding reoperation within 1 week after emergency decompressive craniectomy in s TBI patients was 14.75%(54/366).Multivariate Logistic regression analysis showed that the independent risk factors of bleeding reoperation after emergency decompressive craniectomy in s TBI patients was multiple bleeding sites(OR=3.721,95%CI:1.475,9.386,P=0.005),day or night operation(OR=0.288,95%CI:0.131,0.633,P=0.002),operation time(OR=0.652,95%CI:0.487,0.873,P=0.004) and abnormal intraoperative blood pressure fluctuation(OR=3.578,95%CI:1.455,8.798,P=0.006).The sensitivity and specificity of the nomogram model were 0.815 and 0.680.The area under the receiver operating characteristic curve(ROC)was 0.773 and 95%CI was 0.708-0.838.The internal validation showed the area under ROC was 0.773 and95%CI was 0.708-0.838.Conclusions:Through the study,we obtained the risk factors that affect hemorrhage reoperation after s TBI surgery.Through the analysis of risk factors,the risk nomogram model of the bleeding and reoperation after s TBI was obtained.Compared with other related studies,this prediction model had certain prediction efficiency.