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Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Does time from diagnostic CT until surgical evacuation affect outcome in patients with chronic subdural hematoma?
Shaian Zolfaghari1, Nils Ståhl2, Henrietta Nittby Redebrandt3,2
1The Rausing Laboratory, Division of Neurosurgery, Department of Clinical Sciences Lund, Lund University, 221 85, Lund, Sweden. Shaian.zolfaghari@med.lu.se.
Insights
Delayed surgery for chronic subdural hematoma (CSDH) did not negatively impact patient outcomes. This study found no significant difference in recovery or mortality for CSDH patients experiencing longer waits for surgical evacuation.
Area of Science:
- Neurosurgery
- Neurology
- Surgical Outcomes
Background:
- Chronic subdural hematoma (CSDH) is a common neurosurgical condition often requiring surgery.
- Patients frequently experience delays between diagnosis via CT scan and surgical intervention.
- Limited research exists on the impact of delayed treatment for CSDH.
Purpose of the Study:
- To investigate the effect of delayed surgical evacuation on patient outcomes in CSDH.
- To assess if the time from diagnosis to surgery influences mortality, re-operation rates, hospital stay, and functional recovery.
- To explore the influence of anticoagulants on surgical timing and re-operation risk.
Main Methods:
- Retrospective cohort study of 179 CSDH patients undergoing surgical evacuation.
- Analysis of data from Skåne University Hospital (January 2015 - December 2016).
- Primary outcome measures included mortality, re-operation, hospital duration, discharge disposition, and Glasgow Outcome Scale (GOS).
Main Results:
- Mean time from CT diagnosis to surgery was 76 hours.
- No significant correlation found between delay in surgery and hospital stay, discharge destination, 1-year mortality, or GOS.
- No significant association between anticoagulant use (NOAC, VKA, antiplatelets) and re-operation risk or surgical delay.
- 30-day mortality was too low for statistical significance (n=4).
Conclusions:
- Delayed surgical evacuation for CSDH did not adversely affect patient outcomes in this cohort.
- Favorable outcomes were observed in patients with pre-operative Glasgow Coma Scale (GCS) scores ≥13, regardless of surgical delay.
- The findings suggest that surgical timing may be less critical than patient's pre-operative neurological status for favorable outcomes in CSDH.
Background:
Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Patients diagnosed with CSDH's are often planned for subacute surgery. This means that time from diagnostic CT scan until actual surgery might often be prolonged. There are no previous studies that highlight the effect of delayed intervention in this population.
Method:
Patients that underwent surgical evacuation for a CSDH at Skåne University Hospital between 1 January 2015 and 31 December 2016 were included in this retrospective cohort study (n = 179). The primary aim was to determine if time from initial diagnosis by head-CT until surgical evacuation had a significant effect on outcome. The following was assessed by mortality, re-operation, number of days spent in hospital, discharge to home/institution, and functional outcome assessed by GOS. Secondary aims were to evaluate the effect of NOAC, vitamin K antagonists, and antiplatelet drugs on time from CT to surgery and re-operation frequency.
Results:
Mean time from diagnostic CT scan until surgery was 76 h. No significant relationship was found between time from CT to surgical evacuation and number of days spent in hospital, discharge to own home/institution, 1-year mortality, or outcome assessed by GOS at discharge from hospital. The clear majority (95.5%) of the patients were GCS ≥ 13 pre-operatively. No correlation could be seen between use of NOAC, vitamin K antagonists, or antiplatelet drugs regarding the risk for reoperation within 6 months, and no correlation between the use of these agents and time from CT to surgery. The 30-day mortality was too low to draw any statistically significant conclusions (n = 4).
Conclusion:
In this retrospective cohort study, we could conclude that a delay from initial diagnosis confirming a CSDH to surgical evacuation had no negative effect on outcome when surgery was performed within the time frames and on patients with pre-operatively favorable GCS scores (≥ 13) outlined in our study.
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