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Predictors of functional outcomes and recurrence of chronic subdural hematomas
Henri-Arthur Leroy1, Rabih Aboukaïs1, Nicolas Reyns1
1Department of Neurosurgery, Lille University Hospital, Rue Emile Laine, 59037 Lille Cedex, France.
Insights
Chronic subdural hematoma surgery outcomes are often poor in elderly patients. Age, hematoma thickness, and GCS predict poor functional outcomes, while anticoagulation and residual mass effect predict recurrence.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Radiology
Background:
- Chronic subdural hematoma (CSH) is a prevalent neurosurgical condition, particularly in elderly patients on anticoagulation.
- Restoring patient independence after CSH treatment is a significant clinical challenge.
- Early postoperative CT scans are crucial for evaluating treatment efficacy and recurrence risk.
Purpose of the Study:
- To evaluate functional outcomes following surgical treatment for chronic subdural hematoma (CSH).
- To identify risk factors associated with CSH recurrence after surgical intervention.
- To discuss the role of systematic early postoperative CT scans in managing CSH.
Main Methods:
- Retrospective analysis of 164 surgical procedures in 140 CSH patients (June 2011-June 2012).
- Review of pre- and postoperative CT scans and medical records.
- Functional outcome assessed using the modified Rankin scale (mRS) at 3 months; poor outcome defined as mRS > 2.
Main Results:
- A poor functional outcome (mRS > 2) was observed in 28% of patients.
- Independent predictors of poor outcome included age > 75 years, residual hematoma thickness > 14 mm, and GCS < 15.
- Recurrence occurred in 17% of patients, with independent predictors being preoperative anticoagulant therapy and persistent postoperative mass effect.
Conclusions:
- Over a quarter of CSH patients experience a loss of independence (mRS ≥ 3) three months post-surgery.
- Older age, lower initial Glasgow Coma Scale (GCS), and residual hematoma thickness are associated with poor functional outcomes.
- Anticoagulant therapy and persistent postoperative mass effect significantly increase the risk of CSH recurrence.
Abstract:
We aimed to evaluate the functional outcome and risk factors of recurrence in patients operated on for a chronic subdural hematoma (CSH), and discuss systematic early postoperative CT scans. CSH is a very common disease in neurosurgical practice, especially in elderly patients who are treated with anticoagulation. The challenge is to rapidly restore the independence of these patients. We retrospectively analyzed data from 164 consecutive surgical procedures performed on 140 CSH patients, including recurrent surgery, at our institution from June 2011 to June 2012. Pre- and postoperative CT scans, and medical records, were systematically reviewed using the institutional computing database. A poor functional outcome was defined by a modified Rankin scale (mRS) score>2 at 3 months. Among the 140 patients (mean age 76 years; 64% men), a single burr hole craniostomy was performed in 122 patients, and a craniotomy in 18. A poor functional outcome was recorded in 39 patients (28%; 95% confidence interval [CI] 20-35%). In multivariate analyses, an increased risk of poor functional outcome was associated with age >75 years (odds ratio [OR] 5.88; 95% CI 1.96-17.63), residual hematoma thickness >14 mm (OR 3.79; 95% CI 1.47-9.77), and GCS<15 (OR, 2.96; 95% CI, 1.18-7.40). Recurrences occurred in 24 patients (17%; 95% CI 11-23%), with a median delay to reintervention of 13 days. The independent predictors of CSH recurrence were preoperative anticoagulant therapy (OR 3.68; 95% CI 1.13-12.00), and persistence of mass effect on the postoperative CT scan (OR 5.61; 95% CI 1.52-20.66). Three months after surgical treatment, more than one quarter of the CSH patients had a mRS⩾3. The loss of independence was associated with older age, initial GCS<15, and residual hematoma thickness postoperatively. Anticoagulant therapy and persistence of postoperative mass effect heightened the risk of recurrence.
