Impact of onset timing and operative duration on outcomes in chronic subdural hematoma: an exploratory retrospective...

To investigate how onset timing and operative duration influence recurrence, efficacy, and postoperative recovery in patients with chronic subdural hematoma (CSDH).

We conducted a retrospective analysis of 122 CSDH patients who underwent surgical treatment at the Department of Neurological Surgery, First People's Hospital of Chuzhou City (Affiliated to Anhui Medical University) between January 2016 and October 2024. We collected data on demographics, clinical characteristics, surgical details, and outcome measures including Glasgow Coma Scale (GCS), modified Rankin Scale (mRS), Karnofsky Performance Status (KPS), and Eastern Cooperative Oncology Group (ECOG). Given the exploratory nature of this study and sample size constraints, we employed univariate analyses (independent t-tests, Mann-Whitney U tests, and chi-square tests) to compare outcomes between groups based on onset timing and operative duration, with Spearman correlation analysis used to examine relationships between these factors and prognostic indicators.

Patients with operative duration >60 min (n = 99) had significantly higher postoperative GCS and KPS scores than those with ≤60 min (p = 0.022 and 0.031, respectively). No significant differences were observed between the two groups in postoperative mRS (p = 0.149), ECOG score (p = 0.077), recurrence rate (p = 0.200), or complications (p = 0.605). Correlation analysis showed that operative duration (as a continuous variable) was weakly negatively correlated with postoperative mRS (ρ = -0.197, p = 0.030) and postoperative ECOG (ρ = -0.224, p = 0.013), and weakly positively correlated with postoperative KPS (ρ = 0.258, p = 0.004) and postoperative GCS (ρ = 0.263, p = 0.004). Symptom-to-surgery interval was associated only with longer hospital stay (p < 0.05); statin use showed no significant correlations with any outcome.

In this exploratory analysis, operative duration >60 min was associated with better postoperative GCS and KPS scores in group comparisons, and weak but significant correlations were observed between operative duration and all four functional scales. These associations are likely confounded by baseline differences in patient status and surgical technique. Symptom-to-surgery interval and statin use did not significantly influence short-term prognosis. Larger prospective studies with multivariate adjustment are needed to confirm these preliminary findings.