Outcomes of chronic subdural hematoma with preexisting comorbidities causing disturbed consciousness

Abstract

OBJECTIVE Chronic subdural hematoma (CSDH) is widely treated by drainage through a bur hole opening. However, whether and how preexisting comorbidities causing disturbance of consciousness affect patient outcomes remains unclear. METHODS The authors analyzed 188 consecutive patients with CSDH who were surgically treated at the Neurosurgery Institute of the Kyorin University School of Medicine between 2010 and 2012 and followed them for more than 90 days. The mean patient age was 77.0 years (range 33-101 years) and 56 were women. Patient outcomes including modified Rankin Scale (mRS) score, postoperative morbidity and mortality, and recurrence 90 days after initial surgery were analyzed according to preexisting comorbidities causing disturbance of consciousness. The comorbidities observed in 46 patients (24%) included dementia (30 patients), history of ischemic stroke (10 patients), psychiatric disorders (3 patients), and others (3 patients). RESULTS Background characteristics of patients with comorbidities showed older patient age (p < 0.001), lower preoperative Glasgow Coma Scale score (p < 0.001), and higher preoperative mRS score (p < 0.001). The mean mRS score 90 days after the neurosurgical procedure was 1.2 in all 188 patients, which was significantly higher in those with comorbidities (p < 0.001). By 1-way ANOVA with repeated measures, interaction existed between the presence of comorbidities and mRS score, and improvement of mRS score was observed in smaller proportions of patients with comorbidities (p = 0.002). By multivariate logistic regression analysis, the presence of comorbidities, patient age, reoperation for recurrence, and preoperative mRS score were significantly related to poor outcomes, defined as mRS score of 3 or more at 90 days after surgery. Postoperative morbidity (p < 0.01) and mortality (p < 0.01) were significantly higher in those with comorbidities, whereas the rate of recurrence of CSDH was not significantly different. CONCLUSIONS The preexistence of comorbidities causing disturbance of consciousness affected severity and outcomes 90 days after surgical treatment of CSDH, and comorbidities were also correlated with aging.

The number of burr holes and use of a drain do not interfere with surgical results of chronic subdural hematomas

“…Epidemiological profiles were similar to those expected, with the exception of the mean age being greater than usually observed (63 years old) 2,7 . Presenting symptoms were, respectively, motor deficit (39.4%), headache (9.1%) and impairment of consciousness/mental confusion (8.4%), all in agreement with those described in the literature 3,27 .…”

“…It is characterized by an intracranial hemorrhage with a history of trauma in 50% of patients and occurs predominantly in males and in the elderly 7,10,20,21 . Its incidence has increased considerably due to population aging 21 , reaching 58 patients per 100,000 people in those aged 65 years old or more 4 .…”

“…Its treatment may be conservative or surgical, depending on symptoms and clot size 3,7 . Morbidity and mortality are low, however complications and recurrence are common 7,8 , especially when conditions such as older age, impairment of consciousness, midline shift, postoperative residual hematoma and comorbidities are present 9 .…”

“…Its treatment may be conservative or surgical, depending on symptoms and clot size 3,7 . Morbidity and mortality are low, however complications and recurrence are common 7,8 , especially when conditions such as older age, impairment of consciousness, midline shift, postoperative residual hematoma and comorbidities are present 9 . In surgical cases, several techniques may be applied: one or two burr holes with or without the use of a drain; "twist drill craniostomy", craniotomy, and "endoscopic burr hole" 3,10 .…”

“…Although there is no consensus on the best surgical technique to be employed 7,11,12 , burr hole evacuation of the hematoma has been the most frequently-used procedure and is considered the first option for treatment for CSDH Burr holes, when associated with the use of a drain, have potentially better outcomes 15,16 . However, the literature is still divergent regarding the number of burr holes and the use of the drain 17,18,19 .…”