Effects of Pre-Existing Comorbidities on Outcomes in Patients with Chronic Subdural Hematoma
Hideki Atsumi1, Takatoshi Sorimachi1, Yumie Honda1
1Department of Neurosurgery, Tokai University, Kanagawa, Japan.
Insights
Patients with chronic subdural hematoma (CSDH) often have pre-existing conditions. Hemodialysis, heart failure, and antithrombotic use predict worse outcomes and ADL decline in CSDH patients.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Public Health
Background:
- The aging global population has led to an increase in chronic subdural hematoma (CSDH) patients with pre-existing comorbidities and impaired activities of daily living (ADL).
- Evaluating the impact of these pre-existing conditions on CSDH outcomes is crucial for patient management.
Purpose of the Study:
- To assess ADL worsening in CSDH patients by comparing premorbid ADL with ADL at discharge.
- To identify pre-existing comorbidity-related clinical factors influencing CSDH outcomes.
Main Methods:
- Retrospective analysis of 570 CSDH patients admitted between 2006 and 2016.
- Multivariate analysis to identify clinical factors, including comorbidities, related to outcomes.
- Modified Rankin Scale (mRS) adapted into 5 categories for ADL evaluation.
Main Results:
- 390 patients (68.4%) had pre-existing comorbidities; 120 (21.1%) had premorbid ADL impairment (mRS 2+).
- ADL deteriorated post-CSDH in 92 patients (16.1%), with 173 (30.4%) showing ADL impairment at discharge.
- Hemodialysis and chronic heart failure were linked to ADL deterioration; antithrombotic use predicted acute-on-chronic subdural hematoma, ADL decline, and surgical complications.
Conclusions:
- Hemodialysis, chronic heart failure, and antithrombotic use are key pre-existing comorbidity-linked factors affecting CSDH outcomes.
- Patients with acute-on-chronic subdural hematoma and these factors represent a high-risk group requiring specialized attention.
Objective:
The number of patients with chronic subdural hematoma (CSDH) showing comorbidities and/or impaired activities of daily living (ADL) before the onset of CSDH has increased with the recent aging of society. The purposes of this study were to evaluate ADL worsening by comparing premorbid ADL and ADL at discharge and to investigate the effects of pre-existing comorbidity-related clinical factors on the outcomes.
Methods:
A total of 570 patients with CSDH admitted from 2006 to 2016 were studied retrospectively. Clinical factors, including pre-existing comorbidities, related to outcomes were identified by multivariate analysis. A variation of the modified Rankin Scale (mRS) using 5 united categories of mRS scores 0/1, 2, 3/4, 5, and dead was used for evaluation of ADL.
Results:
Of 570 patients, 390 (68.4%) had pre-existing comorbidities and 120 (21.1%) showed premorbid impaired ADL (mRS scores 2 and worse). Considering pre-existing impaired ADL, ADL deteriorated after CSDH in 92 patients (16.1%), whereas ADL impairment at discharge was found in 173 patients (30.4%). Comorbidities related to ADL deterioration on multivariate analysis were hemodialysis and chronic heart failure. Antithrombotic use for cardiovascular diseases was a predictor of acute-on-chronic subdural hematoma, which was the sole common predictor for ADL deterioration and the occurrence of surgical complications.
Conclusions:
In patients with CSDH, pre-existing comorbidity-linked factors related to outcomes were hemodialysis, chronic heart failure, and antithrombotic use. Patients with acute-on-chronic subdural hematoma with these factors should be regarded as a high-risk group.
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