Impact of clinical characteristics on outcome after surgical management of chronic subdural hematomas: A retrospective analysis
Franziska Meinert (Oldenburg), Marie Broischer (Oldenburg), Simeon Helgers (Oldenburg), Patrick Dömer (Oldenburg), Johannes Woitzik (Oldenburg)
Chronic subdural haematoma (cSDH) is a common neurosurgical condition in elderly patients, with an incidence of 7.4 cases per 100,000 individuals. Despite common surgical evacuation, there remains a significant risk of mortality and recurrence, lacking reliable predictors for postoperative recurrence requiring further intervention.
In this retrospective cohort study, we analysed 60 patients with cSDH who underwent surgical haematoma evacuation between 02/2022 and 01/2023, focusing on the impact of clinical characteristics on recurrence. Postoperatively, imaging control via CT or MRI was conducted to detect potential rebleeding. The degree of disability was assessed using the modified Ranking Scale (mRS) and Glasgow Outcome Scale (GOS) at 4 and 8 weeks after the operation, along with overall survival (OS).
During the observation period (6 months), 16 patients (26.7%) experienced cSDH recurrence. The mean hematoma width for patients with or without recurrence showed no significant statistical difference (p = 0.95). The age of patients with recurrence (75.4 years; ± 9.4) did not significantly differ from those without recurrence (75.7 years; ± 10.2). Females exhibited a lower recurrence rate compared to males (1 vs 15; p = 0.01). Additionally, patients receiving antiplatelet medication at the initial diagnosis had a higher odds ratio for recurrence (OR 4.5, 95% CI 1.07-18.92, p = 0.04). A GCS of 12-14 at diagnosis showed a significantly increased odds ratio for recurrence (OR 5.4, 95% CI 1.27-22.93, p = 0.02) compared to a GCS of 15. Recurrence-free survival time did not significantly differ among age groups or hematoma widths. Moreover, 63.7% of patients without recurrence exhibited a favourable mRS of 0 or 1 after 4 weeks compared to 58.3% with recurrence, though without statistical significance (p = 0.76). GOS categorization revealed slightly higher adverse outcomes in the recurrence group but lacked statistical significance (p = 0.65). Eighth-week measurements hinted at a trend for a favourable outcome post-recurrence.
Our findings suggest that male gender, the use of antiplatelet agents, and a Glasgow Coma Scale (GCS) score below 15 at the initial diagnosis may potentially predict recurrence development, indicating a complicated course following surgical treatment of cSDH.