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Predictive Factors in Development of Postoperative Delirium in Chronic Subdural Hematomas: A Prospective Multicenter
Ismail Zaed1,2, Salvatore Chibbaro3,4, Francesco Marchi1
1Department of Neurosurgery, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland.
Insights
Restraint belt use, electrolyte imbalance, high pain scores, and increased midline shift are key risk factors for delirium after chronic subdural hematoma surgery. Identifying these factors can help predict and manage postoperative delirium in patients.
Area of Science:
- Neurosurgery
- Geriatrics
- Critical Care Medicine
Background:
- Chronic subdural hematoma (CSDH) is a common neurosurgical condition, particularly in the elderly.
- Postoperative delirium is a frequent complication in elderly patients undergoing surgery, leading to increased morbidity and hospital stays.
- Risk factors for delirium specifically in CSDH patients remain under-investigated.
Purpose of the Study:
- To identify independent risk factors for postoperative delirium in patients undergoing surgery for chronic subdural hematoma.
- To analyze clinical indicators associated with delirium development post-CSDH surgery.
- To develop a predictive model for postoperative delirium in this patient population.
Main Methods:
- A prospective study involving 202 consecutive patients with CSDH across European neurosurgical centers.
- Data collection included various clinical indicators and patient demographics.
- Univariate and multivariate regression analyses were employed to identify significant risk factors for delirium.
Main Results:
- Postoperative delirium occurred in 31.2% (63 out of 202) of patients.
- Multivariate analysis identified restraint belt use, electrolyte imbalance, visual analog scale (VAS) pain score, and midline shift as independent predictors of delirium.
- Factors such as age and hematoma thickness were not significant predictors in the multivariate model.
Conclusions:
- Restraint belt use, electrolyte imbalance, elevated VAS pain scores, and greater midline shift are significant risk factors for delirium following CSDH surgery.
- These findings highlight the importance of monitoring and managing these specific factors to mitigate delirium risk.
- The developed prediction models can serve as a valuable reference for clinical risk assessment in CSDH patients.
Abstract:
Introduction: Chronic subdural hematoma (CSDH) is a complex disease with an overall incidence of 1.7-20.6 per 100,000 persons per year and is more commonly encountered in the elderly population. It is projected to be one of the most common neurosurgical procedures. Postoperative delirium is a common complication associated with the elderly, causing increased morbidity and prolonged hospital stay. However, its risk factors in chronic subdural hematoma patients have not been well studied. Methods: A total of 202 consecutive patients with chronic subdural hematoma at different neurosurgical centers in Europe between January 2023 and June 2025 were enrolled. Various clinical indicators were analyzed to identify independent risk factors for postoperative delirium using univariate and multivariate regression analyses. Results: Out of the 202 patients (age, 71 (IQR, 18); female-to-male ratio, 1:2.7) studied, 63 (31.2%) experienced postoperative delirium. Univariate analysis identified age (p < 0.001), gender (p = 0.014), restraint belt use (p < 0.001), electrolyte imbalance (p < 0.001), visual analog scale (VAS) pain score (p < 0.001), hematoma thickness (p < 0.001), midline shift (p < 0.001), hematoma side (p = 0.013), hematoma location (p = 0.018), and urinal catheterization (p = 0.028) as significant factors. Multivariate regression analysis confirmed the significance of restraint belt use (B = 7.657, p < 0.001), electrolyte imbalance (B = -3.993, p = 0.001), VAS pain score (B = 2.331, p = 0.016), and midline shift (B = 0.335, p = 0.007). Hematoma thickness and age had no significant impact. Conclusions: Increased midline shift and VAS pain scores, alongside restraint belt use and electrolyte imbalance, elevate delirium risk in chronic subdural hematoma surgery. Our prediction models may offer a reference value in this context.