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Predictors of Recurrence and Complications After Chronic Subdural Hematoma Surgery: A Population-Based Study
Jiri Bartek1, Kristin Sjåvik2, Helena Kristiansson3
1Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Insights
Predictors for chronic subdural hematoma (cSDH) recurrence include bilateral hematoma and larger diameter. Moderate to severe complications are linked to lower Glasgow Coma Scale scores and higher Charlson Comorbidity Index in patients undergoing burr-hole surgery.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Chronic subdural hematoma (cSDH) is a significant clinical challenge.
- Burr-hole surgery is a common treatment for cSDH.
- Understanding predictors of recurrence and complications is crucial for patient management.
Purpose of the Study:
- To identify independent predictors of recurrence after burr-hole surgery for cSDH.
- To identify independent predictors of moderate to severe complications following burr-hole surgery for cSDH.
Main Methods:
- Retrospective review of 759 adult patients with cSDH treated with burr-hole surgery.
- Analysis of potential predictors for recurrence and complications.
- Multivariable regression modeling was used to identify independent predictors.
Main Results:
- Recurrence occurred in 11.2% of patients.
- Moderate to severe complications occurred in 4.6% of patients.
- Independent predictors of recurrence included bilateral hematoma and larger hematoma diameter. Lower Glasgow Coma Scale (GCS) scores and higher Charlson Comorbidity Index (CCI) predicted complications.
Conclusions:
- Radiological findings such as bilateral hematoma and large diameter predict cSDH recurrence.
- Clinical factors including decreased consciousness (low GCS) and comorbidities (high CCI) predict moderate to severe complications.
- These findings aid in risk stratification and patient counseling.
Objective:
To investigate predictors of recurrence and moderate to severe complications after burr-hole surgery for chronic subdural hematoma (cSDH).
Methods:
A retrospective review was conducted in a Scandinavian single-center population-based cohort of 759 adult patients with cSDH operated with burr-hole surgery between January 1, 2005 and December 31, 2010. Possible predictors of recurrence and complications, assessed using a standardized reporting system of adverse events, were identified and analyzed in univariable analyses. Variables with a P value < 0.10 were included in a multivariable regression model.
Results:
Recurrence was observed in 85 patients (11.2%), whereas moderate to severe complications were observed in 35 patients (4.6%). Bilateral hematoma (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.25-3.35; P < 0.01) and largest hematoma diameter in millimeters (OR, 1.05; 95% CI, 1.01-1.09; P < 0.01) were independent predictors of recurrence in the multivariable model analysis. Glasgow Coma Scale (GCS) score of <13 (OR, 6.06; 95% CI, 2.72-13.51; P < 0.01) and Charlson Comorbidity Index (CCI) >1 (OR, 2.28; 95% CI, 1.10-4.75; P = 0.03) were independent predictors of moderate to severe complications.
Conclusions:
Recurrence after cSDH surgery is more often encountered in patients with radiologically more extensive disease reflected by bilateral hematoma and large hematoma diameter. On the other hand, moderate to severe complications are more often seen in patients in a worse clinical condition, reflected by decreased level of consciousness and more comorbidities.
