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Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Clinical Outcomes in Elderly Patients with Chronic Subdural Hematoma: Validation of Irrigation Assignment Based on
Takuma Maeda1, Yuichiro Kikkawa1,2, Takuro Ehara1
1Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka 350-1298, Japan.
Insights
Elderly patients with chronic subdural hematomas (CSDH) show comparable outcomes to younger patients after burr hole evacuation. However, increased antithrombotic use in the elderly may lead to higher recurrence rates, necessitating long-term monitoring.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Medical Technology
Background:
- Chronic subdural hematomas (CSDH) are increasingly prevalent in the elderly population globally.
- Limited data exists on the specific clinical outcomes for elderly CSDH patients.
- Current therapeutic approaches for CSDH involve burr hole evacuation tailored to hematoma characteristics.
Purpose of the Study:
- To compare postoperative outcomes between elderly and younger CSDH patients.
- To identify predictors of outcomes specifically in elderly CSDH patients.
- To validate the efficacy of a therapeutic method based on hematoma characteristics.
Main Methods:
- A retrospective study included 214 patients undergoing burr hole evacuation for CSDH from April 2018 to March 2022.
- Patients were categorized into elderly (≥65 years) and younger groups for comparative analysis.
- Data collected included baseline characteristics, hematoma features, antithrombotic therapy use, recurrence rates, and clinical outcomes (modified Rankin Scale).
Main Results:
- Elderly patients (44.9%) more frequently used antithrombotic therapy (33.3% vs. 19.5%, p=0.027).
- Initially, elderly patients had fewer favorable outcomes (70.8% vs. 91.5%, p<0.001), but this difference was not significant after adjusting for baseline modified Rankin Scale (mRS).
- Elderly patients exhibited higher recurrence rates (10.4% vs. 2.5%, p=0.021), with baseline mRS being the sole predictor of unfavorable outcomes.
Conclusions:
- Clinical outcomes for elderly CSDH patients undergoing burr hole evacuation are comparable to younger patients when adjusted for baseline severity.
- A higher incidence of preoperative antithrombotic therapy in elderly patients may contribute to increased recurrence rates.
- Long-term follow-up is recommended for elderly CSDH patients due to potentially higher recurrence risk.
Abstract:
The number of elderly patients with chronic subdural hematomas (CSDH) is increasing worldwide; however, there is limited data regarding the clinical outcomes in this population. Our therapeutic method using burr hole evacuation for CSDH is based on the hematoma characteristics, using simple drainage for single-layer lesions and drainage with irrigation for multiple-layer lesions. This study aimed to compare the postoperative outcomes of elderly and younger patients, identify the predictors of outcomes in elderly patients, and verify the validity of our therapeutic methods. In total, we included 214 patients who underwent burr hole evacuation between April 2018 and March 2022. Baseline characteristics, hematoma characteristics, recurrence, and clinical outcomes were compared between the elderly and younger patients. Overall, 96 elderly patients (44.9%) were included in the study, and more elderly patients underwent antithrombotic therapy than younger patients (33.3% vs. 19.5%, p = 0.027). Moreover, elderly patients had significantly fewer favorable outcomes than younger patients (70.8% vs. 91.5%; p < 0.001); however, this was not significant after adjusting for the baseline modified Rankin Scale (mRS). Similarly, elderly patients had higher recurrence rates than younger patients (10.4% vs. 2.5%; p = 0.021). However, the baseline mRS score was the only predictor of unfavorable outcomes. In conclusion, although the clinical outcomes of elderly patients were comparable to those of younger patients, the higher rate of preoperative antithrombotic therapy in elderly patients may result in a higher rate of recurrence requiring a long-term follow-up.
