Daytime versus out-of-hours surgery for Chronic Subdural Hematoma

Area of Science:

• Neurosurgery
• Geriatric Medicine
• Surgical Outcomes Research

Background:

• Chronic Subdural Hematoma (CSH) is a common neurosurgical condition, particularly in the elderly.
• Surgery for CSH is often deferred to out-of-hours (OOH) periods due to patient comorbidities and resource availability.
• Timely surgical intervention is crucial, but OOH scheduling may impact patient outcomes.

Purpose of the Study:

• To evaluate the safety and efficacy of OOH primary surgery for CSH.
• To compare recurrence rates, complications, length of stay, and mortality between in-hours and OOH surgical groups.
• To determine if OOH scheduling for CSH surgery compromises patient care.

Main Methods:

• Retrospective service evaluation of 263 CSH patients undergoing primary surgery between September 2021 and September 2023.
• Defined OOH as operations starting outside 8 am-8 pm.
• Compared outcomes including recurrence, complications, thromboembolic events, length of stay, and mortality using Chi-Squared and Student's t-tests.

Main Results:

• Nearly half (49.8%) of CSH surgeries were performed OOH, with no significant differences in baseline characteristics.
• No significant differences were observed in recurrence rates (14.5% vs. 17.7%), complication rates (13.7% vs. 16.2%), or thromboembolic events (3.8% vs. 3.1%) between OOH and in-hours groups.
• Length of stay (mean 15.9 vs. 15.2 days) and in-hospital mortality (2.3% vs. 3.1%) were also comparable between the groups.

Conclusions:

• Out-of-hours surgery for Chronic Subdural Hematoma is a safe and viable option.
• Scheduling CSH surgery outside standard hours does not negatively impact key patient outcomes.
• OOH surgery should be considered for appropriately selected CSH patients to optimize resource utilization and patient care.