Outcomes of Surgical Evacuation of Chronic Subdural Hematoma in the Aged: Institutional Experience and Systematic Review

Dowlati, Ehsan; Sarpong, Kwadwo; Triano, Matthew; Kamande, Stanley; Black, Jordan; Jeffrey, C.; Anaizi, Amjad; Felbaum, Daniel R.

doi:10.1016/j.wneu.2020.08.118

Cited by 15 publications

(8 citation statements)

References 29 publications

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“…We did not show any difference in the incidence of postoperative surgical complications with the use of general or regional anaesthesia. Our overall surgical complication rate was 20%, which is in line with previous studies [1, 2, 4, 6–8]. In contrast with surgical complications, postoperative medical complications receive little attention in the published literature and the high heterogeneity in reporting methodologies limits extrapolation of the findings [7].…”

Section: Discussionsupporting

confidence: 88%

“…Dowlati et al. showed that 42% of patients have major in‐hospital complications but did provide details as to the type of complication [8]. Stubbs et al.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, the time to become medically fit for discharge and total duration of hospital stay were 3 days and 4 days, respectively. Following CSDH evacuation, hospital duration of stay has been shown to range from 1 to 15 days [4–8, 13, 18]. Hospital duration of stay may depend on many factors, not only related to patients but also to healthcare systems and social disparities.…”

Section: Discussionmentioning

confidence: 99%

“…Second, older patients often have multiple comorbidities and are receiving chronic drug treatments [4][5][6]. Third, pre-operative evaluation can be difficult due to cognitive impairment related to CSDH [7][8][9]. Finally, emergency and unscheduled surgery are associated with increased peri-operative risks [10].…”

Section: Introductionmentioning

confidence: 99%

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Time to medical fitness for discharge following surgical evacuation of chronic subdural haematoma with general or regional anaesthesia: a prospective randomised trial

et al. 2022

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General or regional anaesthesia can be used for chronic subdural haematoma evacuation, but no study has compared these types of anaesthesia in terms of peri-operative outcomes. This single-centre, prospective, randomised study included adult patients (age ≥ 18 years) undergoing surgical chronic subdural haematoma evacuation. Patients were randomly allocated to general (target-controlled total intravenous anaesthesia with propofol and remifentanil) or regional anaesthesia (bilateral scalp block with remifentanil sedation if required). The primary outcome measure was duration of hospital stay, based on the day patients were judged by an investigator blinded from the allocation group to be medically fit for discharge. Secondary outcomes included: rate of regional anaesthesia failure; rate of intra-operative and postoperative adverse events at 24 hours; and pain scores at 24 hours. Data from 60 patients were analysed (30 general anaesthesia and 30 regional anaesthesia). Median (IQR [range]) time until patients were judged medically fit for discharge was 3 (3-3 [2-10]) days and 3 (2-5 [2-15]) days for general and regional anaesthesia, respectively (p = 0.700). Regional anaesthesia failed in two patients. There were more intra-operative adverse events in patients who received general anaesthesia (25 vs. 11, respectively; p = 0.001). The occurrence of postoperative adverse events was similar for general and regional anaesthesia (16 vs. 13 patients, respectively; p = 0.605). In patients requiring chronic subdural haematoma evacuation, general and regional anaesthesia are comparable in terms of duration of time until medically fit for discharge and occurrence of postoperative complications. The rate of intra-operative adverse events (mainly arterial hypotension) is greater with general anaesthesia.

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Section: Discussionsupporting

confidence: 88%

“…Dowlati et al. showed that 42% of patients have major in‐hospital complications but did provide details as to the type of complication [8]. Stubbs et al.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Time to medical fitness for discharge following surgical evacuation of chronic subdural haematoma with general or regional anaesthesia: a prospective randomised trial

et al. 2022

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“…THE definition of Chronic Subdural Hematoma (CSDH) is an abnormal collection of liquefied blood in subdural space that may lead to neurologically consequences [1,2]. The incidence is ranging from 1.72-20.6/100,000 per year [3][4][5].…”

Section: Introductionmentioning

confidence: 99%