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Surgical Delay and Functional Outcome After Surgery for Chronic Subdural Hematoma
Oula Knuutinen1, Jenni Määttä2, Anselmi Kovalainen2
1Department of Neurosurgery, Oulu University Hospital, Oulu, Finland; Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
World Neurosurgery
|March 2, 2025
Summary
Shorter surgical delays for chronic subdural hematoma (CSDH) improve patient functional outcomes. Operating on symptomatic CSDH patients promptly is recommended for better results.
Area of Science:
- Neurosurgery
- Neurology
- Geriatric Medicine
Background:
- Chronic subdural hematoma (CSH) is a common neurosurgical condition, particularly in elderly patients.
- Surgical evacuation is the primary treatment for symptomatic CSH.
- The optimal timing for surgical intervention remains a subject of investigation.
Purpose of the Study:
- To investigate the association between the duration of surgical delay and functional outcomes in patients with chronic subdural hematoma (CSH).
- To identify if earlier surgical intervention for CSH leads to improved patient recovery.
Main Methods:
- Post hoc analysis of the FINISH (The Finnish Study of Intraoperative Irrigation vs. Drain Alone After Evacuation of Chronic Subdural Hematoma) trial.
- Included 589 patients with CSH, analyzing surgical delay times and functional outcomes at 6 months post-surgery using the modified Rankin Scale (mRS).
- Statistical analysis adjusted for confounding factors to assess the impact of surgical delay on outcomes.
Main Results:
- A surgical delay of 22 hours was identified as an optimal cut-off point for favorable functional outcomes.
- Patients undergoing surgery within 22 hours had a lower rate of unfavorable functional outcomes (10.0%) compared to those delayed (>22h, 15.8%).
- Adjusted analysis showed an increased odds of unfavorable outcomes with delayed surgery (OR 1.42, P=0.046), with risk peaking between 72-96 hours; no association found with mortality or adverse events.
Conclusions:
- Shorter surgical delays in chronic subdural hematoma (CSH) are significantly associated with improved functional outcomes.
- These findings support the recommendation for prompt surgical intervention in symptomatic CSH patients.
- Optimizing surgical timing may enhance recovery and reduce long-term disability in CSH patients.
