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Published on: October 15, 2021
Perioperative Predictors of Recurrency in Chronic Subdural Hematoma: A Retrospective Analysis of 150 Consecutive
1Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
Insights
Identifying patients at high risk for chronic subdural hematoma (cSDH) recurrence is crucial. Cortical atrophy and limited midline shift post-surgery are key predictors, enabling better patient management.
Area of Science:
- Neurosurgery
- Radiology
- Medical Statistics
Background:
- Chronic subdural hematoma (cSDH) incidence is rising due to aging populations and anticoagulant use.
- Standard burr-hole evacuation for cSDH has significant recurrence rates, impacting patient outcomes.
- Effective risk stratification is needed to personalize cSDH treatment strategies.
Purpose of the Study:
- To identify independent predictors of cSDH recurrence after surgical treatment.
- To develop and validate a risk stratification score for perioperative patient assessment.
Main Methods:
- A retrospective single-center study included 150 patients surgically treated for cSDH.
- Clinical and radiological data were analyzed using logistic regression.
- A risk score was constructed based on identified predictors.
Main Results:
- Cortical atrophy (OR ≈ 5.77) and delta midline shift (OR per mm ≈ 0.78) were independent predictors of recurrence.
- A 5-point risk score (0-5) was developed, showing good discrimination (AUC = 0.756).
- The score stratified patients into low, moderate, high, and very high-risk categories.
Conclusions:
- Cortical atrophy and limited postoperative midline re-expansion predict cSDH recurrence.
- The proposed scoring system offers a practical tool for perioperative risk stratification.
- Early identification of high-risk patients can guide tailored management strategies.
Objective:
Chronic subdural hematoma (cSDH) is a common neurosurgical condition with increasing incidence due to aging and widespread anticoagulant use. Mortality remains as high as 32%. Burr-hole evacuation with drainage is the standard treatment for uncomplicated cSDH, but recurrence is a major concern, potentially leading to serious outcomes. Identifying high-risk patients is essential to guide tailored strategies.
Methods:
We conducted a retrospective single-center study on 150 consecutive patients treated surgically for cSDH at the Department of Neurosurgery, San Camillo Forlanini Hospital, Rome, Italy. Clinical and radiological data were collected, and reoperation for recurrence was recorded. Logistic regression was used to identify independent predictors and construct a risk stratification score.
Results:
Logistic regression revealed cortical atrophy (odds ratio ˜ 5.77, P = 0.020) and delta midline shift (odds ratio per mm ˜ 0.78, P = 0.028) as independent predictors of recurrence. A risk score was derived by assigning 3 points for cortical atrophy, 2 points for delta shift ≤ 3 mm, 1 point for 4-7 mm, and 0 for ≥ 8 mm. Total scores (0-5) stratified patients into 4 categories (low: 0-1, moderate: 2-3, high: 4, and very high: 5), demonstrating good discrimination (area under the curve = 0.756).
Conclusions:
Cortical atrophy and limited postoperative midline re-expansion are independent predictors of cSDH recurrence. The proposed scoring system provides a practical tool for perioperative risk stratification, supporting early identification of high-risk patients and timely adoption of appropriate management strategies.
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