Incidence of chronic subdural haematoma: a single-centre exploration of the effects of an ageing population with a review of the literature

Abstract

Background Chronic subdural haematoma (cSDH) is a common neurosurgical pathology frequently occurring in older patients. The impact of population ageing on cSDH caseload has not been examined, despite relevance for health system planning. Methods This is a single-centre study from the UK. Operated cases of cSDH (n = 446) for 2015–2018 were identified. Crude and directly standardised incidence rates were calculated. Medline and EMBASE were systematically searched to identify studies reporting on the incidence of cSDH by year, so an estimate of rate of incidence change could be determined. Local incidence rates were then applied to population projections for local catchment area to estimate operated cSDH numbers at 5 yearly intervals due to shifting demographics. Results We identified nine studies presenting incidence estimates. Crude estimates for operative cases ranged from 1.3/100,000/year (1.4–2.2) to 5.3/100,000/year (4.3–6.6). When non-operated cases were included, incidence was higher: 8.2/100,000/year (6.0–11.2) to 48/100,000/year (37.7–61.1). Four pairs of studies demonstrated incidence rate increases of 200–600% over the last 50 years, but data was deemed too heterogeneous to generate formal estimate of incidence change. Local crude incidence of operated cSDH was 3.50/100,000/year (3.19–3.85). Directly standardised incidence was 1.58/100,000/year (1.26–1.90). After applying local incidence rates to population projections, case numbers were predicted to increase by 53% over the next 20 years. Conclusions The incidence of cSDH is increasing. We project a 53% increase in operative caseload within our region by 2040. These are important findings for guiding future healthcare planning.

Management of Chronic Subdural Hematoma: A Systematic Review and Component Network Meta-analysis of 455 Studies With 103 645 Cases

“…Chronic subdural hematoma (CSDH) is a common neurosurgical condition characterized by the accumulation of blood and its breakdown products in the subdural space over time. Estimates of its incidence range from 8.2 to 48 per 100 000 per year, 1-3 which increases with age from 0.2/100 000 in 20 to 29 years to 36/100 000 in 80 to 89 years. 3 This is expected to further increase in line with an aging population and increased usage of antithrombotic medications.…”

“…Estimates of its incidence range from 8.2 to 48 per 100 000 per year, 1-3 which increases with age from 0.2/100 000 in 20 to 29 years to 36/100 000 in 80 to 89 years. 3 This is expected to further increase in line with an aging population and increased usage of antithrombotic medications. 4,5 The development of CSDH is classically attributed to brain cortical atrophy and noncompliance in the elderly patients, resulting in susceptibility to bridging venous injury.…”

Chronic subdural haematoma: the role of peri‐operative medicine in a common form of reversible brain injury

“…However, these rates rise to 8.2–48/100,000 person years when non‐operative cases are included [13]. These figures are primarily drawn from studies in high‐income countries, albeit geographically disparate ones – with broadly comparable findings seen in studies from Europe, Japan, Australia and the Americas [13]. From a health system perspective, a key observation is that case numbers are rising; longitudinal studies demonstrate a two to six‐fold rise in cases over the last 50 years [13].…”

“…Chronic SDH is an increasingly common [13] Evidence clearly shows that there is an important role for integrated peri-operative medicine in the management and research of chronic SDH, both within neurosurgical centres and their referring partner hospitals.…”

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

“…Projections quantified cSDH to become the most prevalent neurosurgical diagnosis requiring treatment by 2030, hence, putting a substantial burden on the health-care systems. [ 1 , 15 , 18 , 19 , 24 , 25 ] Indications for surgical treatment are based on symptomatology and mass effect in the form of hematoma thickness or midline shift. Craniotomy or surgical burr-hole evacuation with irrigation and placement of a drain for 24–48 h is considered standard of care.…”