Predictors of recurrence of chronic subdural haematoma in a cohort study of patients presenting in a sub-Saharan African teaching hospital

Abstract

Background Chronic subdural haematoma (CSDH) is a common neurological condition affecting the elderly with decreased quality of life. Recurrence leads to increase in number of hospital admissions and surgical interventions. Several factors contribute to recurrence of chronic subdural haematoma, and determination of these factors will help institute measures to reduce recurrence of CSDH, cost of care and improved quality of life. The aim of this study was to determine the predictors of recurrence of chronic subdural haematoma in a cohort of patients presenting in a Sub-Saharan African Teaching Hospital. Methods A prospective hospital-based cohort study of 62 participants who presented with CSDH and underwent burr-hole and drainage at the Neuroscience unit of the Korle-bu Teaching Hospital. The primary outcome of this study was the recurrence of CSDH within 3 months after the surgery. Data was entered into Microsoft Excel 2016 and exported to International Business Machine (IBM) Statistical Package for the Social Sciences (SPSS) version 21.0 for analysis. Predictors of recurrence of CSDH were determined using logistic regression with odds ratio calculated at the 95% confidence level and a p-value less than 0.05 accepted as statistically significant. Results There was a male preponderance of 45 (72.6%), over females of 17 (27.4%). The mean age was 63.1 ± 13.6 years. The recurrence rate of CSDH was 21.0% whilst the mortality rate was 4.8%. Facial palsy and dysphasia were associated with the recurrence of CSDH (p = 0.045, 0.029). Hypertension and bilaterality were associated with recurrence of CSDH from a univariate analysis (p = 0.039, OR = 4.865, CI = 0.975–24.285; p = 0.005, OR = 5.979, CI = 1.585–22.557). In a multivariate logistic regression analysis, bilaterality was the only independent predictor of recurrence of CSDH (p = 0.030, AOR = 5.47, CI = 1.18–25.34). Conclusions Both hypertension and bilaterality showed statistically significant association with recurrence of CSDH. However, only bilaterality proved to be an independent predictor of recurrence of CSDH in patient who underwent burr-hole and drainage.

Synthetic minority over-sampling technique-enhanced machine learning models for predicting recurrence of postoperative chronic subdural hematoma

“…In our study, patients with heart disease and diabetes exhibited a tendency towards lower recurrence rates of chronic subdural hematoma (CSDH), although the difference was not statistically significant. This observation contradicts our prior understanding ( 23 , 36 ). We speculate that one possible explanation for this phenomenon could be the long-term medication regimen these patients often require, which includes antihypertensives, glycemic control medications, and anticoagulant or antiplatelet drugs.…”

Current trends and challenges: The landscape of perioperative mortality in intracranial surgeries in low‐ and middle‐income settings: A narrative review

“…POMRs exhibit substantial variability across LMICs, contingent upon the specific surgical procedures and diseases under investigation. In the African context, the literature reveals a broad spectrum of POMRs, with rates ranging between 2.5% and 39.1% for an assortment of intracranial interventions and pathologies 1,4,13–18 . This stands in sharp contrast to the trends observed in North America and Europe, where analogous intracranial surgical interventions have consistently manifested markedly reduced POMRs 19–23 .…”

“…In the African context, the literature reveals a broad spectrum of POMRs, with rates ranging between 2.5% and 39.1% for an assortment of intracranial interventions and pathologies. 1,4,[13][14][15][16][17][18] This stands in sharp contrast to the trends observed in North America and Europe, where analogous intracranial surgical interventions have consistently manifested markedly reduced POMRs. [19][20][21][22][23] Notably, certain studies within these developed regions have even reported an absence of perioperative mortalities.…”

“…These factors include hypertension, diabetes, use of antiplatelets and anticoagulants, alcohol abuse, hematoma laterality, financial constraints, poor acceptance due to ignorance, cultural beliefs, age, gender, preoperative neurological status, altered sensorium, Karnofsky performance status score, and prior treatment history. 1 , 2 , 3 , 4 , 13 , 14 , 15 , 16 , 17 The interplay of these factors has significant potential to impact the overall outcome of intracranial surgeries and consequently contribute to POM.…”

Relationship between Bilateral Chronic Subdural Hematomas and Postoperative Recurrence

“…8,9 Recurrence increases morbidity, the number of surgical procedures performed, and the financial costs of patient management. 3,7,10 Although multiple factors have been cited as having an association with increased recurrence, the risk factors for increased recurrence remain controversial and studies have shown inconsistent results in this regard. 1,4,11 Identification of these factors could decrease the financial burden of the disease and improve the clinical outcome.…”