Abstract: Objective To analyze the risk factors for secondary surgery at distant sites after craniotomy in patients with severe craniocerebral trauma, so as to provide reference for perioperative monitoring and treatment. Methods A retrospective analysis was conducted. A total of 163 cases of severe traumatic brain injury （TBI） were selected from from January 2016 to March 2019, and according to whether secondary surgery was performed at distant sites, they were divided into a secondary surgery group （n=37） and a control group （n=126）. Comparisons were made in trauma site, hematoma site, preoperative Glasgow Coma Scale （GCS） score, and other factors may cause secondary surgery at distant sites, and significant factors were assigned a value based on weight. A multiple logistic regression analysis was also conducted. Results In the secondary surgery group, the good and moderate disability rate was 45.94%, lower than 65.87% in the control group, and the difference was statistically significant （P<0.05）. In the secondary surgery group, the proportions of patients with occipital impact, hematoma on the contralateral or bilateral position, associated injury, decompression by bone flap removal, preoperative PLT < 80×10⁹/L, midline displacement, and distal fracture were higher than those in the control group, and the differences were statistically significant （P<0.05）. Logistic regression analysis results showed that occipital impact + contralateral hematoma, preoperative PLT < 80×10⁹/L, decompression by bone flap removal, and distal fracture were risk factors for secondary surgery of distal part in patients with severe TBI （OR=0.704, 1.573, 4.251, 5.092; 95%CI： 0.517-1.296, 1.106-4.821, 2.592-6.281, 3.702-13.173）. Conclusion Occipital impact + contralateral hematoma, preoperative PLT < 80×10⁹/L, decompression by bone flap removal, and distal fracture are risk factors for secondary surgery at distant sites in patients with severe TBI. Patients with a combinition of these factors should be closely monitored after craniotomy. Once there is an increase in intracranial pressure or change in consciousness, a cranial CT examination should be performed promptly, and an operation should be performed promptly if the indication for secondary surgery in the distal compartment is met.

Key words: Severe traumatic brain injury, After craniotomy, Distant part, Secondary surgery, Risk factor