Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

Christopher, Edward; Poon, Michael T C; Glancz, Laurence; Hutchinson, Peter J.; Kolias, Angelos G.; Brennan, Paul M.; Gray, William Peter

doi:10.1007/s10143-018-0979-4

Cited by 33 publications

(19 citation statements)

References 26 publications

(57 reference statements)

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“…It has been shown that older patients have overall worse outcome after surgical treatment of cSDH. 3 Our data showed that patients ≥ 80 years old show higher complication and mortality rates. Hence, optimal surgical treatment is of paramount importance in geriatric patients.…”

Section: Discussionmentioning

confidence: 58%

Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial

Greuter¹,

Lutz

Fandiño

et al. 2020

Neurosurgical Focus

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OBJECTIVEChronic subdural hematoma (cSDH) occurs more frequently in elderly patients, while older patient age is associated with worse postoperative outcome following burr-hole drainage (BHD) of cSDH. The cSDH-Drain trial showed comparable recurrence rates after BHD and placement of either a subperiosteal drain (SPD) or subdural drain (SDD). Additionally, an SPD showed a significantly lower rate of infections as well as iatrogenic parenchymal injuries through drain misplacement. This post hoc analysis aims to compare recurrence rates and clinical outcomes following BHD of cSDH and the placement of SPDs or SDDs in elderly patients.METHODSThe study included 104 patients (47.3%) 80 years of age and older from the 220 patients recruited in the preceding cSDH-Drain trial. SPDs and SDDs were compared with regard to recurrence rate, morbidity, mortality, and clinical outcome. A post hoc analysis using logistic regression, comparing the outcome measurements for patients < 80 and ≥ 80 years old in a univariate analysis and stratified for drain type, was further completed.RESULTSPatients ≥ 80 years of age treated with an SDD showed higher recurrence rates (12.8%) compared with those treated with an SPD (8.2%), without a significant difference (p = 0.46). Significantly higher drain misplacement rates were observed for patients older than 80 years and treated with an SDD compared with an SPD (0% vs 20%, p = 0.01). Comparing patients older than 80 years to younger patients, significantly higher overall mortality (15.4% vs 5.2%, p = 0.012), 30-day mortality (3.8% vs 0%, p = 0.033), and surgical mortality (2.9% vs 1.7%, p = 0.034) rates were observed. Clinical outcome at the 12-month follow-up was significantly worse for patients ≥ 80 years old, and logistic regression showed a significant association of age with outcome, while drain type had no association with outcome.CONCLUSIONSThe initial findings of the cSDH-Drain trial and the findings of this subanalysis suggest that SPD may be warranted in elderly patients. As opposed to drain type, patient age (> 80 years) was significantly associated with worse outcome, as well as higher morbidity and mortality rates.

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Section: Discussionmentioning

confidence: 58%

Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial

Greuter¹,

Lutz

Fandiño

et al. 2020

Neurosurgical Focus

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“…Chronic subdural hematomas (CSDHs) generally increase with age and are more prevalent in older patients, especial in individuals >65 years old ( 1 ). Although many risk factors may contribute to the occurrence of CSDHs, the pathogenic mechanisms underlying CSDH have remained unclear.…”

Section: Introductionmentioning

confidence: 99%

A Comparative Study of Chronic Subdural Hematoma in Patients With and Without Head Trauma: A Retrospective Cross Sectional Study

Liu

et al. 2020

Front. Neurol.

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Background: The clinical features of chronic subdural hematomas (CSDHs) in patients with and without a history of head trauma have remained unclear. Here, we investigated differences in clinical characteristics in CSDH patients with and without head trauma.Methods: We retrospectively collected clinical characteristics of CSDH patients who had undergone exhaustive drainage strategies via burr-hole craniostomies from August 2011 to May 2019. We divided patients into a trauma group (i.e., head trauma) and a no-trauma group. Chi-square tests or t-tests were used to analyze differences in clinical characteristics between the two groups. Multiple linear regression analysis was performed to analyze the relationships between the clinical characteristics and either reduction of the hematoma cavity or length of the hospital stay in CSDH patients with trauma.Results: We collected data from 1,307 CSDH patients, among whom 805 patients had a history of head trauma whereas 502 patients did not. The mean age of patients with head trauma was 64.0 ± 16.1 years, while that of patients without head trauma was significantly younger at 61.5 ± 17.9 years (p = 0.010). Furthermore, more patients in the no-trauma group had a history of hypertension compared to those in the trauma group (40.2 vs. 32.9%, p = 0.007). Dizziness occurred in 29.2% of patients with trauma and in 23.1% of patients without trauma (p = 0.016). A greater number of patients with trauma showed a reduction of hematoma cavity after surgery compared to that of patients without trauma (p = 0.002). The length of hospital stay in patients with trauma was 7.9 ± 4.5 days, which was longer than that of patients without trauma (7.3 ± 3.7 days, p = 0.016). In contrast, there were no significant different differences between the two groups in terms of the densities of hematomas on computed-tomography scans, complications, mortality rates, recurrence rates, or outcomes.Conclusion: Our findings indicate that there were some noteworthy differences in the clinical and pathogenic characteristics of CSDH patients with and without head trauma. However, our findings also indicate that if an optimal treatment method is employed, such as our exhaustive drainage strategy, similar treatment outcomes can be achieved between these groups.

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“…Chronic subdural hematomas (CSDH) generally increase with age and prevalent in older patients, especial in the population > 65 years old [1] . Many risk factors may contribute to the occurrence of CSDH, while the mechanism of CSDH is still unclear.…”

Section: Introductionmentioning

confidence: 99%

A Comparative Study of Chronic Subdural Hematoma in Patients With and Without Head Trauma

Liu

et al. 2020

Preprint

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Background: Clinical features in chronic subdural hematomas (CSDH) patients with and without history of head trauma are not clear. Here, we seek to investigate difference of clinical characteristics in CSDH patients with and without head trauma.Methods: Retrospectively collected clinical characteristics of CSDH patients, who were performed exhaustive drainage strategy in burr-hole craniostomy from August 2011 to May 2019. Divided patients into trauma and no trauma groups. Chi-square test or t-test was used to analyze differences of clinical characteristics between two groups. Multiple linear regression analysis was performed to analyze relationships between clinical characteristics and reduction of hematoma cavity and length of hospital stay in CSDH patients with trauma.Results: 1,307 CSDH patients were collected. 805 patients occurred history of head trauma, 502 patients without it. Mean age of patients with trauma was 64.0 ± 16.1 years, while 61.5 ± 17.9 years in patients without trauma (p=0.010). More patients occurred hypertension in without trauma group than trauma group (40.2% vs 32.9%, p=0.007). Dizziness occurred in 29.2% patients with trauma, 23.1% in patients without trauma (p=0.016). Reduction of hematoma cavity after surgery in patients without trauma was less than ones with trauma (p=0.002). Length of hospital stay in patients with trauma was 7.9 ± 4.5 days, which was longer than patients without trauma (7.3 ± 3.7 days, p=0.016). No significantly different densities of hematoma on CT, complications, mortality, recurrence rate and outcome were found between two groups.Conclusion: Pathogenesis and some clinical characteristics occur differences in CSDH patients with and without trauma, but if we choose an optimal treatment method, such as our exhaustive drainage, and we can achieve the same effect.

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Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

Cited by 33 publications

References 26 publications

Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial

Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial

A Comparative Study of Chronic Subdural Hematoma in Patients With and Without Head Trauma: A Retrospective Cross Sectional Study

A Comparative Study of Chronic Subdural Hematoma in Patients With and Without Head Trauma

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