Temporal delays in XXXX craniotomies.

@entity1 @entity131 @entity4282 @entity3439 @entity16 @entity341 @entity772 @entity130
UNASSIGNED: OBJECTIVE The @entity131 Foundation recommendation regarding the timing of surgical evacuation of @entity4282 and @entity3439 is to perform the procedure as soon as possible. Indeed, faster evacuation is associated with better outcome. However, to the authors' knowledge, no study has looked at where delays in intrahospital care occurred for @entity1 suffering from traumatic intracranial mass lesions. The goals of this study were as follows: 1) to characterize the performance of a Level 1 @entity130 center in terms of delays for @entity130 , 2) to review step by step where delays occurred in @entity1 care, and 3) to propose ways to improve performance. METHODS A retrospective review was conducted covering a 5-year period of all @entity130 . Demographic data, injury severity, @entity16 , and functional outcome data were collected. The time elapsed between @entity341 ( @entity341 ) arrival and CT imaging, between CT imaging and arrival at the operating room (OR), between @entity341 arrival and OR arrival, between OR arrival and skin incision, and between @entity341 arrival and skin incision were calculated. @entity1 were also subcategorized as either having immediate life-threatening emergencies (E0) or life-threatening emergencies (E1). The operative technique was also reviewed (standard craniotomy opening vs immediate bur hole decompression followed by craniotomy). RESULTS The study included 166 @entity1 . Of these, 58 (35%) were classified into the E0 group and 108 (64.2%) into the E1 group. The median @entity341 -to-CT delay was 54 minutes with no significant difference between the E0 and the E1 groups. The median CT-to-OR time delay was 57 minutes. The median delay for the E0 group was 39 minutes and that for the E1 group was 70 minutes (p = 0.002). The median delay from @entity341 to OR arrival for @entity1 with a CT scanning done at an outside hospital was 75 minutes. The median delay from @entity341 to OR arrival was 85 minutes for the E0 group and 127 minutes for the E1 group (p < 0.0001). The median delay from OR arrival to skin incision was 35 minutes (E0: median 27 minutes; E1: median 39 minutes; p < 0.0001). The median total time elapsed between @entity341 arrival and skin incision was 150 minutes (E0: median 131 minutes; E1: median 180 minutes). Overall, only 17% of @entity1 underwent immediate bur hole decompression, but the proportion climbed to 41% in the E0 group. A lower Glasgow @entity772 Scale score was associated with a shorter delay (p = 0.0004). CONCLUSIONS A long delay until surgery still exists for @entity1 requiring urgent mass lesion evacuation. Many factors contribute to this delay, including performing imaging and transfer to and preparation in the OR. Strategies can be implemented to reduce delays and improve the delivery of care.
