In-hospital mortality rates, complication rates, length of stay, and total costs of >14,000 chronic subdural hematomas treated in the U.S. between 2016 and 2020: Query of the premier health-care database

Abstract

Background: With the drastically aging population in the U.S., chronic subdural hematomas (cSDHs) are projected to represent the most common neurosurgical diagnosis requiring treatment within the next two decades. There is lack of contemporary outcome data in patients treated for nontraumatic and nonacute subdural hematoma. We aim to portray current mortality rates, complication rates, length of stay, and costs associated with inpatient cSDH care. Methods: The Premier Health-care Database, Premier Inc., Charlotte/NC was queried for encounters October 2016–December 2020 with the ICD-10 diagnoses of nontraumatic nonacute subdural hematoma as the principal diagnosis among patients age ≥40 years. Per database in-hospital mortality is defined as mortality in an inpatient who is not discharged. Complications represent medical conditions not present on admission that affects mortality, length of stay, and costs within the database. Results: The query identified 14,136 inpatient encounters. Between October 2016 and December 2020, in-hospital mortality rates averaged 10.9% in the medical group (MG) and 3.6% in the surgical group (SG) (P < 0.001). Complication rates averaged between 8.9 % in the MG and 19.9% in the SG (P < 0.001). LOS averaged 3.0 days in the MG and 5.7 days in the SG (P < 0.001). Total costs averaged $ 10,233 in the MG and $ 26,658 in the SG. Conclusion: The standardized outcomes presented represent an objective benchmark of contemporary cSDH treatment outcomes in the U.S. With the projected substantial increase of cSDH cases within the next decades, new treatment strategies such as middle meningeal embolization need to be explored and outperform current outcome metrics.

Emerging Management of Chronic Subdural hematoma (CSDH) in High-Income Country (HIC) and Low-Income Country (LIC)

“…A recent study done in the United States from 2016 to 2020 found that inpatient care for CSDH led to higher in-hospital death rates, complication rates, length of stay, and total costs for the surgical group than for the medical group. 46 While this investigation did not explicitly examine the influence of socioeconomic status on the availability of neurosurgical intervention for CSDH, it implies that the modality of treatment administered could have implications for both clinical outcomes and financial burden.…”

Middle meningeal artery embolization for chronic subdural hematoma: an effective treatment with a bright future

“…cSDH carries a high morbidity, mortality, and healthcare resource burden. 5 Existing medical and surgical treatments, while effective, are imperfect, with recurrence rates of up to 20% 6 and reoperation rates of 12%. 7 These high rates were considered acceptable given the limited alternatives; adjunct medical treatment is at best moderately helpful, 8 and at worst, harmful.…”