Functional Outcome in Patients with Chronic Subdural Hematoma: Postoperative Delirium and Operative Procedure

Area of Science:

• Neurosurgery
• Geriatric Medicine
• Neurology

Background:

• Chronic subdural hematoma (CSDH) is a common neurosurgical condition with typically good outcomes.
• An aging population and increased comorbidities are leading to poorer prognoses in CSDH patients.
• Identifying risk factors for poor outcomes is crucial for optimizing treatment strategies.

Purpose of the Study:

• To identify risk factors for poor prognosis in patients undergoing primary surgery for CSDH.
• To evaluate the impact of operative procedures, including irrigation, on functional outcomes and postoperative delirium.
• To assess the relationship between postoperative delirium and hospitalization duration.

Main Methods:

• Retrospective analysis of 108 patients who underwent primary CSDH surgery between 2016 and 2017.
• Procedures included simple drainage with or without irrigation.
• Functional outcome at discharge was assessed using the modified Rankin Scale (mRS), with analysis of factors including delirium and operative technique.

Main Results:

• 27% of patients experienced a worsened mRS score at discharge, primarily due to mobility or cognitive decline.
• Significant predictors of poor outcome included higher age (OR=5.13), poor pre-hospital mRS (OR=1.57), and preoperative consciousness disturbance (OR=5.13).
• Irrigation was associated with a higher incidence of postoperative delirium (OR=4.83) and longer hospital stays (P=0.028), while operative procedure type did not significantly impact outcome or recurrence.

Conclusions:

• Higher age, pre-hospital functional status, and preoperative consciousness disturbance are key risk factors for poor recovery after CSDH surgery.
• Surgical irrigation may increase the risk of postoperative delirium and prolong hospitalization.
• Further research into optimizing surgical techniques to mitigate these risks is warranted.