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Outcomes of chronic subdural hematoma in patients with liver cirrhosis

Ching-Chang Chen1, Shao-Wei Chen2, Po-Hsun Tu1

  • 1Departments of1Neurosurgery and.

Journal of Neurosurgery
|February 3, 2018
PubMed

Insights

Liver cirrhosis significantly worsens surgical outcomes for chronic subdural hematoma patients undergoing burr hole craniostomy. Patients with liver cirrhosis face higher mortality, complications, and costs, indicating a poor prognosis even after simple procedures.

Area of Science:

  • Neurosurgery
  • Hepatology
  • Public Health

Background:

  • Burr hole craniostomy is a standard treatment for chronic subdural hematoma (CSH).
  • Outcomes and recurrence rates of CSH surgery in patients with liver cirrhosis (LC) are not well-established.

Purpose of the Study:

  • To investigate the surgical outcomes and recurrence of CSH in patients with LC compared to those without LC.
  • To analyze mortality, complications, repeat procedures, and medical costs associated with CSH surgery in patients with and without LC.

Main Methods:

  • Retrospective nationwide population-based cohort study using the Taiwan National Health Insurance Research Database.
  • Included 29,163 patients undergoing first-time craniostomy for CSH (2001-2013).
  • 1223 patients with LC were matched with 2446 control patients without LC for analysis of outcomes.

Main Results:

  • Patients with LC had significantly higher in-hospital mortality (8.7% vs 3.1%), hospital admissions, ICU stays, blood transfusions, and medical expenditures.
  • LC patients were more likely to require extended craniotomy for CSH removal.
  • Worsening LC severity correlated with poorer surgical outcomes.

Conclusions:

  • Liver cirrhosis is a significant comorbidity associated with poor prognosis in patients undergoing craniostomy for CSH, even after minor head trauma.
  • Craniostomy for CSH in patients with LC leads to increased mortality, complications, and healthcare costs.
  • The severity of liver cirrhosis directly impacts surgical outcomes for chronic subdural hematoma.

Keywords:
CCI = Charlson Comorbidity IndexCIC = catastrophic illness certificateCSDH = chronic SDHCTP = Child-Turcotte-PughICD-9-CM = International Classification of Diseases, 9th Revision, Clinical ModificationLC = liver cirrhosisNHI = National Health InsuranceNHIRD = NHI Research DatabaseSDH = subdural hematomaTBI = traumatic brain injuryburr holechronic subdural hematomacraniostomyliver cirrhosisvascular disorders

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