Long-term survival after chronic subdural haematoma

Manickam, Appukutty; Marshman, Laurence A.G.; Johnston, Ross

doi:10.1016/j.jocn.2016.05.026

Cited by 35 publications

(28 citation statements)

References 17 publications

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“…Mortality after CSDH was highest in the oldest patients over 85 years old, but the standardized mortality ratio was lower than in any other age group. Manickam et al reported excess mortality continuing throughout a prolonged follow-up (median 5.2 years) as peers lived 12.4 years longer [25]. A prospective, randomized study by Santarius et al revealed that among operatively treated patients, CSDH drainage significantly reduced 6-month mortality from 18 to 9% [33].…”

Section: Comparison Of the Current Findings To Prior Literaturementioning

confidence: 99%

“…CSDH has been considered to be relatively benign, but during the last years, it has been recognized to have worse outcome than earlier assumed [11,25,29]. It has been speculated that CSDH may be a sentinel health event, and a harbinger of subsequent morbidity and mortality [3,11,29].…”

Section: Introductionmentioning

confidence: 99%

“…It is not possible to draw reliable conclusions on the excess mortality related to CSDH without comparing these patients to a matched sample from the general population. To date, only four studies (Table 1) have compared mortality after CSDH with anticipated survival [11,16,25,29]. All of these studies have shown varied excess mortality, but the follow-up periods have extended only up to 8 years.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, there are no prior studies reporting long-term mortality in CSDH patients compared with a matched sample from the general population in an unselected, population-based series. Additionally, only two studies have previously reported the causes of death after a diagnosis of CSDH [19,25].…”

Section: Introductionmentioning

confidence: 99%

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Long-term excess mortality after chronic subdural hematoma

et al. 2020

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Objective To assess possible long-term excess mortality and causes of death of patients with chronic subdural hematoma (CSDH). Methods A retrospective study (1990-2015) of adult patients (n = 1133, median age = 76 years old, men = 65%) with CSDH identified by ICD-codes and verified by medical records. All patients were followed until death or the end of 2017. Cumulative relative survival ratios and relative excess risks of death (RER) were estimated by comparing patients' mortality with that in the entire regional matched population. The causes of death were compared with a separate reference group formed by randomly choosing sex, age, and calendar time matched controls (4 controls per each CSDH patient). Results The median follow-up time was 4.8 years (range = 0-27 years), and 710 (63%) of the patients died (median age at death = 84 years old). The cumulative excess mortality was 1 year = 9%, 5 years = 18%, 10 years = 27%, 15 years = 37%, and 20 years = 48%. A subgroup of CSDH patients (n = 206) with no comorbidity had no excess mortality. Excess mortality was related to poor modified Rankin score at admission (RER = 4.93) and at discharge (RER = 8.31), alcohol abuse (RER = 4.47), warfarin (RER = 2.94), age ≥ 80 years old (RER = 1.83), non-operative treatment (RER = 1.56), and non-traumatic etiology (RER = 1.69). Hematoma characteristics or recurrence were unrelated to excess mortality. Dementia was the most common cause of death among the CSDH patients (21%) and the third most common cause in the reference group (15%, p < 0.001). Conclusions Patients with CSDH have continuous excess mortality up to 20 years after diagnosis. Patient-related characteristics have a strong association with excess mortality, whereas specific CSDH-related findings do not. CSDH patients have an increased risk for dementia-related mortality.

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Section: Comparison Of the Current Findings To Prior Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term excess mortality after chronic subdural hematoma

et al. 2020

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“…Alternatively regular craniotomy is performed which, if necessary, might be accompanied by membranectomy [8]. Among surgically treated patients, about 52% to 77% result with good functional outcome [5,[9][10][11]] and 3-month mortality rate is reported between 8% and 22% [10,[12][13]. One of the predictors of poor treatment outcome is cSDH recurrence [3,14].…”

Section: Introductionmentioning

confidence: 99%

Early reoperations in chronic subdural hematoma

Kwinta

Krzyżewski

Kliś

et al. 2018

Medical Research Journal

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Background: The recurrence rate of chronic subdural hematoma (cSDH) is high and early reoperation is often required. Aim: The aim of this study was to evaluate prognostic factors for early reoperation of chronic subdural hematomas (cSDH) treated by classical and minimally invasive approach. Materials and Methods: We retrospectively analyzed the medical history of 355 cSDH patients treated with formal craniotomy and minimally invasive burr hole craniostomy. We determined the potential predictors of early reoperations. Results: A total of 33 (9.3%) patients required early reoperation. Those patients more often underwent craniotomies instead of burr hole craniostomies (36.4% vs. 62.7%, p < 0.01) and took steroids before hospitalization (3.0% vs. 0.3%, p = 0.04) than non-reoperated patients. Patients who had surgery on the right side were less likely to be reoperated (51.9% vs. 33.3%, p = 0.04). On multivariate analysis the frontal (OR = 5.284, 95% CI: 1.293-21.76, p = 0.019) and large craniotomy (OR = 2.297, 95% CI: 1.004-5.258, p = 0.048) remained independent risk factors for early reoperation of cSDH. Conclusions: Neurosurgeons should consider the evacuation of a cSDH with help of minimally invasive burr hole craniostomy in most of the cases, as well as avoid large and frontal and craniotomies in order to prevent early reoperation of cSDH.

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Impact of Early Resumption of Oral Anticoagulation on Recurrence After Surgery for Chronic Subdural Hematoma in Patients With Atrial Fibrillation: A Target Trial Emulation

Anno,

Fukasawa,

Shinozaki

et al. 2024

Pharmacoepidemiology and Drug

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PurposeClinicians treating patients with atrial fibrillation (AF) on oral anticoagulants who undergo surgery for chronic subdural hematoma (CSDH) face a dilemma: while early postoperative resumption of anticoagulation is necessary to prevent embolism, it may increase the risk of CSDH recurrence. To date, however, no study has evaluated this question while adequately addressing common biases in observational studies. Here, we assessed this issue using target trial emulation framework.MethodsWe identified patients undergoing initial CSDH surgery who had received anticoagulation for AF preoperatively from two hospital‐based administrative databases (2014–2022). We compared two treatment strategies: resumption of anticoagulation within 14 days postoperatively versus no resumption during this period. Using a three‐step method of cloning, censoring, and weighting, we estimated the risk of CSDH recurrence, along with the risk ratio and risk difference at postoperative day 90.Results291 CSDH patients with AF were eligible, of whom 29 (10.0%) underwent CSDH reoperation. The weighted estimated 90‐day reoperation risk was 11.7% (95% confidence interval [CI], 6.0 to 14.3) for resuming anticoagulation within 14 days postoperatively and 9.4% (95% CI, 4.1 to 12.8) for not resuming within 14 days, corresponding to a risk ratio of 1.20 (95% CI, 0.67 to 2.36) and risk difference of 1.9% (95% CI, −4.0 to 6.6).Conclusions90‐day risk of CSDH recurrence may not differ between early and non‐early resumption of anticoagulation, although early resumption could modestly accelerate recurrence. Allowing for the imprecision of the estimates, these findings provide important insights for clinical decision‐making regarding anticoagulation resumption.

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Long-term survival after chronic subdural haematoma

Cited by 35 publications

References 17 publications

Long-term excess mortality after chronic subdural hematoma

Long-term excess mortality after chronic subdural hematoma

Early reoperations in chronic subdural hematoma

Impact of Early Resumption of Oral Anticoagulation on Recurrence After Surgery for Chronic Subdural Hematoma in Patients With Atrial Fibrillation: A Target Trial Emulation

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