Rates of Repeated Operation for Isolated Subdural Hematoma Among Older Adults

Knopman, Jared; Link, Thomas; Navi, Babak B.; Murthy, Santosh B.; Merkler, Alexander E; Kamel, Hooman

doi:10.1001/jamanetworkopen.2018.3737

Cited by 19 publications

(5 citation statements)

References 35 publications

(45 reference statements)

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“…14,[28][29][30][31][32][33][34][35] A 2018 review of adults older than 65 years (2,831,274 cases in the NSQIP registry and 1,952,305 Medicare beneficiaries) found that the rate of postoperative hematoma recurrence requiring repeat surgery was between 5% and 10%. 36 For example, a Scandinavian population-based multicenter study of 1254 patients undergoing primary burr hole craniotomy found no statistically significant difference between surgical complications, perioperative morbidity, or perioperative mortality in patients older than 90 years versus those younger than 90 years. 29 Conversely, Krupa et al 32 found a dramatic difference in outcome when comparing burr hole craniotomy and standard craniotomy in the young (age < 40 years)…”

Section: Discussionmentioning

confidence: 99%

Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases

Joyce

Bounajem

Scoville

et al. 2020

Neurosurgical Focus

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OBJECTIVEThe incidence of already common chronic subdural hematomas (CSDHs) and other nonacute subdural hematomas (NASHs) in the elderly is expected to rise as the population ages over the coming decades. Surgical management is associated with recurrence and exposes elderly patients to perioperative and operative risks. Middle meningeal artery (MMA) embolization offers the potential for a minimally invasive, less morbid treatment in this age group. The clinical and radiographic outcomes after MMA embolization treatment for NASHs have not been adequately described in elderly patients. In this paper, the authors describe the clinical and radiographic outcomes after 151 cases of MMA embolization for NASHs among 121 elderly patients.METHODSIn a retrospective review of a prospectively maintained database across 15 US academic centers, the authors identified patients aged ≥ 65 years who underwent MMA embolization for the treatment of NASHs between November 2017 and February 2020. Patient demographics, comorbidities, clinical and radiographic factors, treatment factors, and clinical outcomes were abstracted. Subgroup analysis was performed comparing elderly (age 65–79 years) and advanced elderly (age > 80 years) patients.RESULTSMMA embolization was successfully performed in 98% of NASHs (in 148 of 151 cases) in 121 patients. Seventy elderly patients underwent 87 embolization procedures, and 51 advanced elderly patients underwent 64 embolization procedures. Elderly and advanced elderly patients had similar rates of embolization for upfront (46% vs 61%), recurrent (39% vs 33%), and prophylactic (i.e., with concomitant surgical intervention; 15% vs 6%) NASH treatment. Transfemoral access was used in most patients, and the procedure time was approximately 1 hour in both groups. Particle embolization with supplemental coils was most common, used in 51% (44/87) and 44% (28/64) of attempts for the elderly and advanced elderly groups, respectively. NASH thickness decreased significantly from initial thickness to 6 weeks, with additional decrease in thickness observed in both groups at 90 days. At longest follow-up, the treated NASHs had stabilized or improved in 91% and 98% of the elderly and advanced elderly groups, respectively, with > 50% improvement seen in > 60% of patients for each group. Surgical rescue was necessary in 4.6% and 7.8% of cases, and the overall mortality was 8.6% and 3.9% for elderly and advanced elderly patients, respectively.CONCLUSIONSMMA embolization can be used safely and effectively as an alternative or adjunctive minimally invasive treatment for NASHs in elderly and advanced elderly patients.

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Section: Discussionmentioning

confidence: 99%

Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases

Joyce

Bounajem

Scoville

et al. 2020

Neurosurgical Focus

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“…The recurrence of cSDH after surgical treatment remains a major issue, with 5% to 10% of patients requiring repeated operation after 30 to 90 days [ 44 ]. In particular, refractory cases, sometimes defined as more than two recurrences, pose a special challenge.…”

Section: Discussionmentioning

confidence: 99%

Controversies in the Surgical Treatment of Chronic Subdural Hematoma: A Systematic Scoping Review

et al. 2022

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Chronic subdural hematoma (cSDH) is one of the most common neurosurgical entities, especially in the elderly population. Diagnosis is usually established via a head computed tomography, while an increasing number of studies are investigating biomarkers to predict the natural history of cSDH, including progression and recurrence. Surgical evacuation remains the mainstay of treatment in the overwhelming majority of cases. Nevertheless, many controversies are associated with the nuances of surgical treatment. We performed a systematic review of the literature between 2010 and 2022, aiming to identify and address the issues in cSDH surgical management where consensus is lacking. The results show ambiguous data in regard to indication, the timing and type of surgery, the duration of drainage, concomitant membranectomy and the need for embolization of the middle meningeal artery. Other aspects of surgical treatment—such as the use of drainage and its location and number of burr holes—seem to have been adequately clarified: the drainage of hematoma is strongly recommended and the outcome is considered as independent of drainage location or the number of burr holes.

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“…Based on the prior literature [3][4][5][6][7][8][9][10][11][12][13] and our univariate analyses (Supplementary Table 1, http://links.lww.com/NEU/D210), there were 10 factors potentially associated with either LTF or readmission: age, operation type, transfer status, distance from hospital, ADI, insurance, length of stay (LOS), mRS at discharge, number of comorbidities, and disposition. Owing to the limited number of patients who were LTF and/or readmitted, using all 10 factors in multivariable analysis was not a reasonable choice given the risk of model overfitting.…”

Section: Principal Components Analysismentioning

confidence: 99%

“…Several previous studies have examined the factors associated with unplanned readmission in patients with aSDH. 3-9 In addition, some studies have examined loss to follow-up (LTF) in neurosurgical populations. 10-13 No previous neurosurgical studies have evaluated the factors associated with LTF specifically in patients with aSDH or studied LTF side-by-side with unplanned readmission as similar postdischarge adverse outcomes.…”

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confidence: 99%

Loss to Follow-up and Unplanned Readmission After Emergent Surgery for Acute Subdural Hematoma

et al. 2022

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BACKGROUND:Loss to follow-up (LTF) and unplanned readmission are barriers to recovery after acute subdural hematoma evacuation. The variables associated with these postdischarge events are not fully understood.OBJECTIVE:To determine factors associated with LTF and unplanned readmission, emphasizing socioeconomic status (SES).METHODS:A retrospective analysis was conducted of surgical patients with acute subdural hematoma managed operatively from 2009 to 2019 at a level 1 regional trauma center. Area Deprivation Index (ADI), which is a neighborhood-level composite socioeconomic score, was used to measure SES. Higher ADI corresponds to lower SES. To decrease the number of covariates in the model, principal components (PCs) analysis was used. Multivariable logistic regression analyses of PCs were performed for LTF and unplanned readmission.RESULTS:A total of 172 patients were included in this study. Thirty-six patients (21%) were LTF, and 49 (28%) patients were readmitted; 11 (6%) patients were both LTF and readmitted (P = .9). The median time to readmission was 10 days (Q1: 4.5, Q3: 35). In multivariable logistic regression analyses for LTF, increased ADI and distance to hospital through PC2 (odds ratio [OR] 1.49; P = .009) and uninsured/Medicaid status and increased length of stay through PC4 (OR 1.73; P = .015) significantly contributed to the risk of LTF. Unfavorable discharge functional status and nonhome disposition through PC3 were associated with decreased odds of unplanned readmission (OR = 0.69; P = .028).CONCLUSION:Patients at high risk for LTF and unplanned readmissions, as identified in this study, may benefit from targeted resources individualized to their needs to address barrier to follow-up and to ensure continuity of care.

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Rates of Repeated Operation for Isolated Subdural Hematoma Among Older Adults

Cited by 19 publications

References 35 publications

Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases

Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases

Controversies in the Surgical Treatment of Chronic Subdural Hematoma: A Systematic Scoping Review

Loss to Follow-up and Unplanned Readmission After Emergent Surgery for Acute Subdural Hematoma

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